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Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive bacteria and expanded Gram-negative coverage compared to second-generation agents.

Cephalosporins are Beta-Lactam drugs that are bactericidal agents that inhibit bacterial cell wall synthesis by binding to one or more of the pencillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. (See Cephalosporin mechanism of action)


Treatment of the following infections when caused by susceptible organisms:

  • lower respiratory tract infections
  • acute bacterial otitis media
  • skin and skin structure infections
  • urinary tract infections
  • uncomplicated gonorrhea
  • pelvic inflammatory disease
  • bacterial septicemia
  • bone and joint infections
  • intra-abdominal infections
  • meningitis
  • surgical prophylaxis

[edit] DOSAGE

ADULTS: The usual adult daily dose is 1 to 2 grams given IV/IM once a day (or in equally divided doses twice a day) for 4-14 days, depending on type and severity of infection


  • Acute Bacterial Otitis Media: 50 mg/kg IM in single dose; not to exceed 1 g
  • For the treatment of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses twice a day). The total daily dose should.not exceed 2 grams.
  • For the treatment of serious miscellaneous infections other than meningitis, the recommended total daily dose is 50 to 75 mg/kg, given in divided doses every 12 hours for 4-14 days. The total daily dose should not exceed 2 grams.

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  • Patients with known allergy to the cephalosporin class of antibiotics
  • Neonates (≤28 days): ceftriaxone can displace bilirubin from serum albumin. It should not be administered to hyperbilirubinemic neonates, especially prematures.
  • Ceftriaxone is contraindicated in neonates if they require (or are expected to require) treatment with calcium-containing IV solutions, including continuous calcium containing infusions such as parenteral nutrition because of the risk of precipitation of ceftriaxone-calcium. Cases of fatal reactions with ceftriaxone-calcium precipitates in lung and kidneys in neonates have been described.


  • Clostridium difficile associated diarrhea : Treatment with Ceftriaxone alters the normal flora of the colon leading to overgrowth of C. difficile.
  • Interaction with Calcium-Containing Products (See contraindications)
  • Hypersensitivity:


  • Interaction with Calcium-Containing Products: ceftriaxone for injection and IV calcium-containing solutions should not be mixed or co-administered. Diluents containing calcium, such as Ringer’s solution or Hartmann’s solution should not be used.

Ceftriaxone is also contraindicated in newborns receiving concurrent administration of calcium-containing solutions or products due to risk of fatal precipitation in lungs and kidneys.


  • Pregnancy Category B (US). Ceftriaxone should be used during pregnancy only if clearly needed.
  • Nursing Mothers: Low concentrations of ceftriaxone are excreted in human milk. Caution should be exercised when ceftriaxone for injection is administered to a nursing woman.


Common side effects include local irritation, pain, induration and tenderness at the injections site, rash (1.7%), and diarrhea (2.7%).

  • Hypoprothrombinaemia leading to an increased physiological risk for bleeding is a rare adverse effect to Ceftriaxone
  • Ceftriaxone therapy in children is linked to renal stones and pediatric acute renal failure (PARF). Predominant symptoms included sudden-onset anuria for at least 24 hours, flank pain, excessive crying, and/or vomiting. Early diagnosis and prompt pharmacological therapy are important in relieving the condition. Retrograde ureteral catheterization is an effective treatment of those who fail to respond to pharmacotherapy.
  • Ceftriaxone may precipitate in bile, causing biliary sludge and gallstones. The condition appears to be transient and reversible upon discontinuation of the drug.
  • Ceftriaxone may cause allergic reactions similar to those caused by penicillin. Due to the 3-8% cross allergenicity with penicillins, caution should be used in those with a history of severe allergies to penicillin.


ß-Lactams: Mechanisms of Action and Resistance