Ceftriaxone: Difference between revisions

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*Max: 4g/24h
*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




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*First Dose: 50-100mg/kg IM/IV x 1
*First Dose: 50-100mg/kg IM/IV x 1
*Max: 4g/24h
*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


===Indications by Disease===
===Indications by Disease===

Latest revision as of 11:07, 20 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

General

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


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

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

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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