Ceftriaxone: Difference between revisions

(Restructured: Added dynamic Indications by Disease tables under Adult and Pediatric sections (filtered by Has Population). Kept manual dosing until all disease templates are annotated. Removed old standalone Indications table.)
(Replace manual Adult/Pediatric dosing sections with dynamic SMW #ask tables; dosing info now sourced from disease templates via {{AntibioticDose}})
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==Adult Dosing==
==Adult Dosing==
===Indications by Disease===
===Indications by Disease===
{{#ask:
{{#ask: [[Has DrugName::Ceftriaxone]] [[Has Population::Adult]]
[[Has DrugName::Ceftriaxone]]
|?Treats disease=Disease
[[Has Population::Adult]]
|?Has Dose=Dose
|?Treats disease=Disease
|?Has Context=Context
|?Has Dose=Dose
|format=table
|?Has Context=Context
|limit=50
|format=table
|mainlabel=-
|limit=50
|headers=show
|mainlabel=-
|sort=Treats disease
|headers=show
|sort=Treats disease
}}
}}
===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==
==Pediatric Dosing==
===Indications by Disease===
===Indications by Disease===
{{#ask:
{{#ask: [[Has DrugName::Ceftriaxone]] [[Has Population::Pediatric]]
[[Has DrugName::Ceftriaxone]]
|?Treats disease=Disease
[[Has Population::Pediatric]]
|?Has Dose=Dose
|?Treats disease=Disease
|?Has Context=Context
|?Has Dose=Dose
|format=table
|?Has Context=Context
|limit=50
|format=table
|mainlabel=-
|limit=50
|headers=show
|mainlabel=-
|sort=Treats disease
|headers=show
|sort=Treats disease
}}
}}
===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==
==Special Populations==
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| ||[[Peptostreptococcus sp.]]||'''S'''
| ||[[Peptostreptococcus sp.]]||'''S'''
|}
|}
===Key===
===Key===
{{Template:Antibacterial Spectra Key}}
{{Template:Antibacterial Spectra Key}}

Revision as of 20:44, 19 March 2026

General

  • Type: 3rd generation 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

Indications by Disease

DiseaseDoseContext
Acute cystitis1gm IV QDInpatient
Acute cystitis250mg IM x1Urethritis Concern
Acute diarrhea2g IV once daily x 5 daysSalmonella
Cellulitis1g (50mg/kg) IV q24hrsFreshwater
CervicitisIM x 1 (500mg if <150kg, 1g if ≥150kg)GC/Chlamydia, Standard
Discitis2g IV dailyInpatient Therapy
Endocarditis1g (50mg/kg) IM or IVDental Procedure Prophylaxis
Epididymitis500 mg IM in a single doseSTI
Epidural abscess (spinal)standard dosingEmpiric
Erysipelas1g (50mg/kg) IV once daily x 10 daysInpatient
Gonorrheal conjunctivitis1g IM single doseGonococcal Conjunctivitis
Infectious tenosynovitis1g IV dailyEmpiric
Mammalian bites1g (50mg/kg) IV onceSevere mammalian bite infection
Mastoiditis1g (50mg/kg) IV once dailyEmpiric
Open fracture2 g IV (immediately x 1 total dose)Grade III Fractures
Orbital cellulitis2 g IV q12hrInpatient
Pelvic inflammatory disease500mg IM x1 (1g if >150kg)Outpatient; combined with Doxycycline and Metronidazole
Pelvic inflammatory disease1g IV q24hrInpatient; combined with Doxycycline and Metronidazole
Peritonitis1g IV once dailyPrimary
Pneumonia (main)1-2g IVICU, Low Risk
Pneumonia (main)1–2g dailyInpatient, CAP Non-ICU
Prostatitis1g IV q12hrsSeptic
Prostatitis500mg IM x1STD Associated
Pyelonephritis1gm IV QDAdult Inpatient
Sinusitis1-2g IV q12-24h x 7-10 daysSinusitis, Severe
Surgical prophylaxis2g IV within 60 minutes of incisionSurgical prophylaxis
Syphilis2gm IV once daily for 10-14 daysNeurosyphilis, Alternative
Typhoid fever2g IV q 24 hrs x 14 daysQuinolone Resistant, Parenteral
Urethritis in menIM x 1 (500mg if <150kg, 1g if ≥150kg)Uncomplicated, Gonorrhea

Pediatric Dosing

Indications by Disease

DiseaseDoseContext
Acute cystitis50-75mg/kg IV daily (max 2g)Pediatric Inpatient
Acute diarrhea50mg/kg/day once daily x 3 daysPediatric travelers diarrhea
Acute diarrhea50mg/kg IM/IV daily x 5 days (max 2g)Pediatric Shigella Severe
Acute diarrhea50-75mg/kg IV daily x 5 days (max 2g)Pediatric Salmonella
Acute diarrhea50mg/kg/day once daily x 3 daysPediatric travelers diarrhea
Diarrhea aguda50mg/kg/day once daily x 3 daysPediatric travelers diarrhea
Acute otitis media50mg/kg IM once as single injection x 3 daysTreatment Failure
Endocarditis100mg/kg/day IV divided q12h (max 4g/day)Pediatric Empiric
Epidural abscess (spinal)50-75mg/kg IV daily (max 2g)Pediatric Empiric
Erysipelas50mg/kg IV daily (max 2g) x 10 daysPediatric Inpatient
Gonorrheal conjunctivitis25-50mg IV or IM, max 125mgGonococcal Conjunctivitis, Newborn
Infectious tenosynovitis100mg/kg IV once dailyPediatrics
Mammalian bites50mg/kg IV daily (max 2g)Pediatric Severe
Mastoiditis50mg/kg IV daily (max 2g)Pediatric Empiric
Neonatal conjunctivitis25-50mg/kg IV or IM x1 (max 125mg)Gonococcal conjunctivitis
Open fracture50mg/kg IV (max 2g) x 1Pediatric Grade III
Orbital cellulitis50mg/kg IV q12hrs (max 2g/dose)Pediatric Inpatient
Osteomyelitis50mg/kg IV once dailySickle Cell Disease
Pediatric fever of uncertain source50-100mg/kg/doseNeonatal 14-28 days with Ampicillin
Pediatric fever of uncertain source50-100mg/kg/dose90 days to 36 months
Peritonitis50-75mg/kg IV daily (max 2g)Pediatric
Pneumonia (peds)50mg/kg/day q24hrs IV (max 2g/dose)Hospitalized moderately ill not fully immunized
Pyelonephritis75mg/kg IV QDPediatric Inpatient
Sinusitis50mg/kg IV daily (max 2g); for severe or treatment failurePediatric Sinusitis, Severe
Traveler's diarrhea50mg/kg/day once daily x 3 daysPediatric travelers diarrhea
Typhoid fever50-80mg/kg IV daily x 10-14 days (max 2g)Pediatric, Quinolone Resistant
Ventriculoperitoneal shunt infection100mg/kg/day IV div q12-24hrsEmpiric with Vancomycin

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 Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep S
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium X1
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis I
C. jeikeium R
L. monocytogenes R
Gram Negatives N. gonorrhoeae I
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos R
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia I
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi S
Vibrio vulnificus X1
Misc Chlamydophila sp X1
Mycoplasm pneumoniae X1
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces S
Bacteroides fragilis R
Prevotella melaninogenica I
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum X1
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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