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    Due to Aeromonas hydrophilia: 1-2 g IV q Day in combination with doxycycline Due to Vibrio vulnificus; 1 g IV q Day in combination with doxycycline Continue treatment until further debridement not necessary, clinical improvement observed, and patient is afebrile for 48-72 hr Uncomplicated gonococcal infection of pharynx, cervix, urethra, or rectum: ceftriaxone 250 mg IM once plus azithromycin 1 g PO once (preferred) or alternatively, doxycycline 100 mg PO q12hr for 7 days CDC STD guidelines: MMWR Recomm Rep. June 5, 20(RR3);1-137 Gonococcal conjunctivitis: 1 g IM once Disseminated gonococcal infection: 1 g/day IV/IM; continued for at least 24-48 hours after improvement is observed, then continued with cefixime 400 mg PO q12hr to complete at least 1 week of therapy Gonococcal endocarditis:1-2 g IV q12hr for 4 weeks Gonococcal meningitis: 1-2 g IV q12hr for 10-14 days Acute epdidymitis: 250 mg IM once with doxycycline Agranulocytosis Anaphylaxis Anemia Basophilia Bronchospasm Candidiasis Chills Diaphoresis Dizziness Dysgeusia Flushing Gallstones Glycosuria Headache Hematuria Hemolytic anemia Increased alkaline phosphatase or bilirubin Increased creatinine Jaundice Leukocytosis Lymphocytosis Lymphopenia Monocytosis Nausea Neutropenia Phlebitis Prolonged or decreased prothrombin time (PT) Pruritus Renal stones Serum sickness Thrombocytopenia Urinary casts Vaginitis Vomiting Pancreatitis, stomatitis and glossitis Oliguria, ureteric obstruction, post-renal acute renal failure Exanthema, allergic dermatitis, urticaria, edema; acute generalized exanthematous pustulosis (AGEP) and isolated cases of severe cutaneous adverse reactions (erythema multiforme, Stevens-Johnson syndrome or Lyell’s syndrome/toxic epidermal necrolysis) Convulsion 10-g pharmacy bulk package should not be used for direct infusion Immune-mediated hemolytic anemia reported; if patient develops anemia while on ceftriaxone, stop antibiotic until etiology determined; severe hemolytic anemia, including fatalities, reported in both adults and children May increase INR, especially in nutritionally deficient patients, hepatic or renal disease or prolonged treatment Dosage must be adjusted in severe renal insufficiency (high dosages may cause CNS toxicity) Superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy Use with caution in patients with history of penicillin allergy Use with caution in patients with history of GI disease, especially colitis Use with caution in breast-feeding women; drug may displace bilirubin from albumin-binding sites, increasing risk of kernicterus Abnormal gallbladder sonograms reported, possibly the result of ceftriaxone-calcium precipitates; discontinue if signs or symptoms of gallbladder diseease occur Ceftriaxone-calcium precipitates in urinary tract observed in patients receiving ceftriaxone; may be detected as sonographic abnormalities; patients may be asymptomatic or may develop symptoms of urolithiasis, and ureteral obstruction and post-renal acute renal failure; appears to be reversible upon discontinuation of therapy and institution of appropriate management; ensure adequate hydration; discontinue therapy in patients who develop signs and symptoms suggestive of urolithiasis, oliguria or renal failure and/or the sonographic findings Clostridium difficile-associated diarrhea (CDAD reported with use of nearly all antibacterial agents, including ceftriaxone; If CDAD suspected or confirmed, may consider discontinuing ongoing antibacterial use not directed against C. difficile; institute appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation Pancreatitis secondary to biliary obstruction reported rarely; use with caution in patients with gallbladder, biliary tract, liver, or pancreatic disease and patients with history of penicillin hypersensitivity Inform patients that use of local anesthetics may cause methemoglobinemia, which must be treated promptly; advise patients or caregivers to stop use and seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue Use with caution in patients with history of GI disease (eg, colitis) Third-generation cephalosporin with broad-spectrum gram-negative activity; has lower efficacy against gram-positive organisms but higher efficacy against resistant organisms; highly stable in presence of beta-lactamases (penicillinase and cephalosporinase) of gram-negative and gram-positive bacteria; bactericidal activity results from inhibiting cell-wall synthesis by binding to 1 or more penicillin-binding proteins; exerts antimicrobial effect by interfering with synthesis of peptidoglycan (major structural component of bacterial cell wall); bacteria eventually lyse because activity of cell-wall autolytic enzymes continues while cell-wall assembly is arrested Distributed throughout body, including gallbladder, lungs, bone, bile, and CSF (higher concentrations achieved when meninges are inflamed); crosses placenta; enters amniotic fluid and breast milk Protein bound: 85-95% Vd: 6-14 L 10 mg/m L; compatible at 1 mg/m L) Additive: Aminophylline, clindamycin, linezolid, theophylline, metronidazole (at metronidazole 15 g/L with ceftriaxone 20 g/L; compatible at metronidazole 7.5 g/L with ceftriaxone 10 g/L) Syringe: Lidocaine (variable) Y-site: Alatrofloxacin, amphotericin B cholesteryl sulfate, amsacrine, filgrastim, fluconazole, labetalol, pentamidine, vinorelbine, vancomycin General: Calcium-containing drugs The above information is provided for general informational and educational purposes only. 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