KEY POINTS
- Ceftriaxone (Rocephin) is a third-generation cephalosporin and beta-lactam antibiotic that inhibits cell wall synthesis in susceptible bacteria
- Has activity versus Gram negatives (e.g., Proteus, E. coli, Klebsiella sp.) and Gram positives (e.g., Streptococcus pneumoniae), but lacks any substantial anti-anaerobic activity
- Commonly used in combination with azithromycin for community acquired pneumonia requiring hospitalization
- Has utility versus a wide array of infections, including urinary tract infection, infective endocarditis, otitis media, gonococcal infection, meningitis, and skin, soft tissue, bone or joint infection
- Can be combined with ampicillin for treatment of Enterococcal infective endocarditis
- Has a long half-life, so typically dosed daily in adults, but more severe infections (e.g., meningitis) may require twice daily dosing
- Usual adults doses are 1 gm daily, 2 gm daily or 2 gm BID
- In recent years there have been pushes for higher doses
- Can be given IV push or IM
- The IM shots are sometimes mixed with lidocaine to reduce pain
- No adjustments for renal or hepatic infection, but some recommend not to exceed 2 gm per day with concurrent renal and hepatic dysfunction
- NOT recommended for use in hyperbilirubinemic neonates
- Highly associated with collateral damage (i.e., the ecological consequences of antibiotic use – such as the induction and spread of antimicrobial resistance mechanisms, as well as Clostridium difficile infection)
RESOURCES
- Ceftriaxone package insert / prescribing information
- IDSA Practice Guidelines
- Surgical Prophylaxis Guidelines
- 2015 CDC STD Guideline
- Mayo Clinic 1999 Cephalosporin Review
- Collateral Damage of Cephalosporin or Quinolone Antibiotic Therapy
- FDA Safety Information On Ceftriaxone
- Ampicillin Plus Ceftriaxone For Enterococcal Infective Endocarditis
- SIDP Journal Club Series: Ceftriaxone Outpatient Parenteral Antimicrobial Therapy for Methicillin-Susceptible Staphylococcus aureus Bloodstream Infection
