CEFTRIAXONA - Incompatibilidad con soluciones que contienen calcio - Mayo 2010

18-05-10
Información destinada a profesionales de la salud

CEFTRIAXONA. Incompatibilidad con soluciones que contienen calcio

Health Canada (1) publicó una actualización, de la información referida a la prescripción de ceftriaxona en los hospitales.  Las nuevas recomendaciones están basadas en el resultado de dos estudios recientes in vitro, que mostraron un incremento en el riesgo de formación de precipitados de calcio-ceftriaxona en el plasma neonatal.
Contraindicaciones:
- ceftriaxona está contraindicada es neonatos, que requieren tratamiento con soluciones intravenosas que contengan calcio, incluso infusiones de nutrición parenteral, debido al riesgo de formación de un precipitado ceftriaxona-calcio.
Precauciones:
- en pacientes no neonatos, las soluciones que contienen calcio y ceftriaxona pueden ser administradas secuencialmente si la vía de infusión es lavada enteramente, con un fluido compatible, entre ambas infusiones.
- los diluyentes que contienen calcio, tales como la solución de Ringer o la solución de Hartmann, no deben ser usadas para reconstituir viales de ceftriaxona o para diluir viales reconstituidos, para administración intravenosa, debido a que se puede formar un precipitado. Ceftriaxona no debe ser administrada simultáneamente con soluciones intravenosas que contengan calcio, incluyendo infusiones de nutrición parenteral, usando un vía con sitio Y.
Se notifica que no se han reportado interacciones entre ceftriaxona y productos de administración oral que contengan calcio ni interacciones entre ceftriaxona intramuscular y productos que contengan calcio (intravenoso u oral).
Ceftriaxona es una cefalosporina de amplio espectro y de acción prolongada para uso parenteral. Está indicado en el tratamiento de infecciones del tracto respiratorio bajo, infecciones del tracto urinario, septicemia bacteriana, infecciones de la piel y sus estructuras, infecciones de huesos y articulaciones, infecciones intra-abdominales y meningitis, cuando son causadas por microorganismos susceptibles. Está también indicada en el tratamiento de la gonorrea no complicada y en profilaxis de pacientes sometidos a determinados procesos quirúrgicos.
La Agencia Reguladora de Medicamentos y Productos Médicos (MHRA) del Reino Unido (2) ha  enfatizado que ceftriaxona no debería ser dada simultáneamente con soluciones que contengan calcio (incluidas soluciones de nutrición parenteral total) para administración intravenosa, debido al riesgo de formación de un precipitado de calcio. La ceftriaxona está contraindicada en recién nacidos hasta los 28 días de edad que necesiten tratamiento intravenoso con soluciones que contengan calcio, incluyendo soluciones de nutrición parenteral total, tanto como aquéllos que presenten ictericia, hipoalbuminenia o acidosis, debido a que son condiciones en las cuales la unión a bilirrubina está, probablemente, alterada.
Los profesionales de la salud están advertidos que el calcio y la ceftriaxona pueden ser infundidos secuencialmente en pacientes mayores de 28 días de edad si: - la vía de infusión es lavada entre soluciones, o – las infusiones son dadas por vía diferentes o en sitios diferentes.
La MHRA explica que una revisión de los datos disponibles sugieren que los recién nacidos (menores de 28 días de edad) tuvieron un riesgo mucho mayor de precipitación ceftriaxona-calcio que los pacientes mayores, particularmente si eran prematuros o presentan deficiencia de unión a bilirrubina. El riesgo de precipitación del complejo calcio-ceftriaxona en adultos probablemente sea menor, no obstante, es de precaución; por lo que la ceftriaxona y el calcio no deberían ser administrados simultáneamente por vía intravenosa.
La agencia también advierte que algunas soluciones de nutrición parenteral contienen niveles similares de calcio a las contenidas en las soluciones salinas tales como la de Ringer y Hartmann, y pueden presentar un similar grado de riesgo.

Referencias:
(1) Advisories, Warnings and Recalls, Health Canada. 15 de Octubre de 2009
(www.hc-sc.gc.ca).
(2) Drug Safety Update, MHRA,Volume 3, Issue 3, Octubre de 2009
(www.mhra.gov.uk).


Información extraída y traducida de Who Pharmaceuticals Newsletter Nº 6, 2009 y Nº 1, 2010, disponible en: http://www.who.int/medicines/publications/newsletter/2009news6_1.pdf


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