INDICES> ceftriaxone

["Dr.L.Offerhaus" <lo@euronet.nl>]

Dear Mr.Duncan,

I sympathize with your cephalosporin problem; I am not surprised 
because the pattern is well known both in developing countries and 
in Eastern Europe. Ceftriaxone is one of the more expensive group 
4 cephalosporins and is certainly not indicated for general use. In 
practice in formularies and treatment guidelines in Western Europe 
its use is mainly restricted to (a) resistant gonorrhoea and (b) Lyme 
disease. It is useful in H.Influenzae meningitis, but probably not 
superior to (cheaper) cefotaxime. For all the other indications for 
which it is used (salmonellosis and shigellosis, osteomyelitis, 
syphilis, chancroid) other better and/or cheaper alternatives are 
available. Even when one takes the longer duration of action (i.e. 
convenience of administration) of cetriaxone into account it remains 
more expensive than the alternatives. I suspect that the widespread 
use of the drug in your region has something to do with overactive 
marketing.

The paediatric dosages recommended in the literature are:
(Kucers & Bennett) 50-100 mg/kg in 1-2 divided doses, but single 
doses of 50 mg/kg per day will do for most infections;
(O'Grady et al.) 20-50 mg/kg per day as single dose, only in severe 
infections up to 80 mg/kg, but then i.v.;
(Australian Therapeutic Guidelines 1998): As Kucers & Bennett.
The lower dose as recommended by the British textbook is probably 
quite sufficient for most instances. BUT if one uses it for the right 
indication - and the only one which is justified in paediatrics is 
bacterial meningitis (!) then one has to deal with a serious and life-
threatening infection, and then one has to use the higher dose i.v.

Good luck!
Dr.L.Offerhaus
Koedijklaan 1a, NL-1406KW Bussum, The Netherlands
Phone: +31-35-6923288.  Fax: +31-35-6923290
E-mail: LO@EURONET.NL  CompuServe: 71530,15
Eur J Clin Pharmacol ONLY:
POB 75552, NL-1070AN Amsterdam, The Netherlands


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