Clinical Question PID tx.

[Hayduke]

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Hi-
I have traditionally treated PID with a "gram and a shot" (Rocephin 250mg IM and Azithromycin 1g po) followed by 10 days of Doxy. My hospital has recently disallowed nurses mixing ANY meds resulting in Ceftriaxone available only in IV form in quantities of 1g.

I recall from med school a concept of antibiotic "overshoot" but I have lost all detail.

Can you drug gurus give me a cogent explanation for this phenomenon, or alternatively, can you give a good non-economic reason why the IM route is superior?
Thanks.

 

[njac]

No idea why your hospital is doing that. I live by the Rocephin 125mg IM in my ED. Hell, it comes in 250mg vials! However, I think where I am now it comes from the pharmacy because they dilute it with lidocaine. Some hospitals have take then 797 thing a couple steps too far.

Anyway, what are you doing for Gonorrhea in pcn-allergic patients? In light of the CDC recs not to use Fluoroquinolones?

 

[Its Z]

Hi-
I have traditionally treated PID with a "gram and a shot" (Rocephin 250mg IM and Azithromycin 1g po) followed by 10 days of Doxy. My hospital has recently disallowed nurses mixing ANY meds resulting in Ceftriaxone available only in IV form in quantities of 1g.

I recall from med school a concept of antibiotic "overshoot" but I have lost all detail.

Can you drug gurus give me a cogent explanation for this phenomenon, or alternatively, can you give a good non-economic reason why the IM route is superior?
Thanks.

Lazy Pharmacy department unwilling to provide mixing service is probably one reason. Another is the infamous USP 797 requirement for IV and injectable admixture policies that requires a certainly level of sterile environment to mix drugs.

As far as therapeutic effectiveness, I guess IM > PO.... yet you're not going to establish an IV access for an outpatient ED visit.

Also, in ED and clinicis, IM administration allows for a larger reimbursement vs. providing a PO med and then a prescription.

I would insist to the P&T and hospital admin that pharmacy prepare IM drugs for ED... obviously P&T didn't look at the whole picture when they made a decision to forego IM administration.

 

[njac]

Don't forget that Cefixime 400mg po x1 is also indicated for the Gonorrhea; but that's not always on formulary.

 

[Its Z]

Don't forget that Cefixime 400mg po x1 is also indicated for the Gonorrhea; but that's not always on formulary.

But when given in ED, is it billable and reimbursed?

 

[njac]

But when given in ED, is it billable and reimbursed?

if we make them take it right there in front of us I believe so - that's not a discharge prescription, it's a "take this now" just like zofran.

 

[Hayduke]

Thanks for the replies.
Now any thoughts on the overshoot question. Why the 125mg (or 250)? We dose up Ceftriaxone at 1g for most of its indications. Is there some pharmacokinetic magic I don't know?

 

[Its Z]

Thanks for the replies.
Now any thoughts on the overshoot question. Why the 125mg (or 250)? We dose up Ceftriaxone at 1g for most of its indications. Is there some pharmacokinetic magic I don't know?

Ceftriaxone is dirt cheap now.. like less than $2 per 1 gram. And giving 1 gram aint going to hurt no one.