Ceftriaxone

General
  • Type: 3rd generation Antibiotic class::Cephalosporin
  • Dosage Forms: injectable solution, powder for injection
  • Dosage Strengths: injectable solution: 1g/50mL, 2g/50mL; powder for injection: 250mg, 500mg, 1g, 2g, 10g, 100g
  • Routes of Administration: IV, IM
  • Common Trade Names: Rocephin

Adult Dosing

General
  • 1-2g IM/IV q24h
  • First ED Dose: 1g IM/IV x 1
  • Max: 4g/24h

Bacterial Meningitis
  • 4g IV divided q12-24h x 7-21 days
  • First ED Dose: 2g IM/IV x 1

Gonococcal
  • Uncomplicated, initial: 250mg IM x 1
    • Also treat for chlamydia regardless of test results
  • Uncomplicated, recurrent of persistent: 500-1000mg IM x 1
  • Disseminated: 1g IM/IV q24h
    • May switch to cefixime PO after 24-48h if clinical improvement
  • Conjunctivitis: 1g IM x 1
  • Prophylaxis (sexual assault victims)
    • 250mg IM x 1

PID
  • 250mg IM x 1
  • Use with doxycycline +/- metronidazole

Sinusitis, Severe
  • 1-2g IV q12-24h x 7-10 days

Endocarditis
  • 1g IM/IV x 1
    • 30-60 min before procedure

Proctitis, Epididymitis, Chancroid
  • 250mg IM x 1
    • Give with doxycycline

Surgical Prophylaxis
  • 1g IV x 1
    • Give 0.5-2h preop

Typhoid Fever
  • 60mg/kg IV q24h x 2wk
  • Max: 4g/24h

Pediatric Dosing

General (<7 Days Old)
  • 50mg/kg IM/IV q24h
  • First Dose: 50mg/kg IM/IV x 1

General (7 Days - 1 Month)
  • <2000g
    • 50mg/kg IM/IV q24h
    • First Dose: 50mg/kg IM/IV x 1
  • >2000g
    • 50-75mg/kg IM/IV q24h
    • First Dose: 50-75mg/kg IM/IV x 1

General (>1 Month - Adult)
  • 50-100mg/kg IM/IV divided q12-24h
  • First Dose: 50-100mg/kg IM/IV x 1
  • Max: 4g/24h

Acute Otitis Media (2 Months - 12 Years)
  • 50mg/kg IM/IV x 1
  • Give 50mg/kg IM/IV q24h x 3 days for recurrent infection
  • Max 1g/dose

Bacterial Meningitis
  • 80-100mg/kg IV divided q12-24h x 7-21 days
  • First Dose: 100mg/kg IV x 1
  • Max: 4g/24h

Pneumonia, Community-Acquired (>3 Months)
  • 50-100mg/kg/day IM/IV divided q12-24h x 10 days
  • First Dose:
  • Max: 2g/day
  • Info: May switch to PO when possible to complete course

Special Populations
  • Pregnancy Rating: B
  • Lactation: Probably safe
  • Renal Dosing
    • Adult
      • Renal failure: No initial adjustment, monitor serum levels
      • Hemodialysis: give dose after dialysis, no supplement
      • Peritoneal Dialysis: 750mg q12h
    • Pediatric
      • CrCl <10: give q24h
      • Hemodialysis: 50mg/kg q24, no supplement
      • Peritoneal Dialysis: 50mg/kg q24, no supplement
  • Hepatic Dosing
    • Adult
      • Hepatic and renal disease: max 2g/day, unless closely monitoring serum levels
    • Pediatric
      • May requrire dose adjustment but specific dosing not defined

Contraindications
  • Allergy to class/drug (see also Cephalosporin Cross-reactivity)
  • Patients <1 month old
    • Hyperbillirubinemia
    • IV calcium containing product
    • If a 3rd generation cephalosporin is required, consider using Cefotaxime instead

Adverse Reactions

Serious

Common
  • Local infection site reaction
  • Eosinophilia
  • Thrombocytosis
  • Transaminitis
  • Diarrhea
  • Leukopenia

Pharmacology
  • Half-life: 5.8-8.7h, 15h (CrCl 5-15)
  • Metabolism: CYP450
  • Excretion: Primarily urine
  • Mechanism of Action: bactericidal; inhibits cell wall synthesis

Antibiotic Sensitivities[1]
Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepS
Strep. anginosus gpX1
Enterococcus faecalisR
Enterococcus faeciumX1
MSSAS
MRSAR
CA-MRSAR
Staph. EpidermidisI
C. jeikeiumR
L. monocytogenesR
Gram NegativesN. gonorrhoeaeI
N. meningitidisS
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posR
Serratia spS
Serratia marcescensX1
Salmonella spS
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.S
Citrobacter freundiiS
Citrobacter diversusS
Citrobacter sp.S
Aeromonas spS
Acinetobacter sp.R
Pseudomonas aeruginosaR
Burkholderia cepaciaI
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaS
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaS
Haemophilus ducreyiS
Vibrio vulnificusX1
MiscChlamydophila spX1
Mycoplasm pneumoniaeX1
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesS
Bacteroides fragilisR
Prevotella melaninogenicaI
Clostridium difficileX1
Clostridium (not difficile)S
Fusobacterium necrophorumX1
Peptostreptococcus sp.S

Key
  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References
  1. Sanford Guide to Antimicrobial Therapy 2014
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