Ceftriaxone

General

• Type: 3rd generation cephalosporins
• Dosage Forms: IM, IV
• 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

• Anaphylaxis
• Broncospasm
• Stevens-Johnson Syndrome
• Toxic Epidermal Necrolysis
• Erythema multiforme
• Serum sickness
• Pneumonitis
• Neutropenia
• Leukopenia
• Hemolytic anemia
• Thrombocytopenia
• Hypoprothrombinemia
• Agranulocytosis
• Superinfection
• Clostridium difficile
• Colitis
• Billiary/gallbladder sludge
• Jaundice
• Pancreatitis
• Seizures
• Nephrolithiasis
• Lung/kidney calcium precipitate (neonates)

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

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

• Antibiotics (Main)

References

Authors

Ross Donaldson, Michael O'Brien, MD, Daniel Ostermayer