CEFTRIAXONE

Third generation broad spectrum cephalosporin antibacterial

Dosage Forms

Powder for injection

1 g

Uses

  • Acute bacterial meningitis
  • Septicaemia
  • Pneumonia
  • Abnormal vaginal/urethral discharge syndrome
  • Pelvic inflammatory disease
  • Severe gonococcal infection
  • Gonococcal eye infection in new born infant
  • Dysentery

Dose and Duration

IV injection should be given slowly over 2–5 minutes. Give IV infusion over 30–60 minutes in neonates
Meningitis (first line treatment)
Adult: 2 g IV or deep IM injection daily in 1 or 2 divided doses for 14 days
Child:50–100 mg/kg daily in 1 or 2 divided doses for 14 days
Neonate: 20–50 mg/kg daily in 1 or 2 divided doses (maximum 50 mg/kg) for 14 days
Septicaemia
Adult:2 g IV or deep IM injection daily in 1 or 2 divided doses for 10 days
Child: 50–100 mg/kg daily in 1 or 2 divided doses for 10 days
Child 1-4 years: 100 mg once daily for 5−7 days
Neonate: 20–50 mg/kg daily in 1 or 2 divided doses (max 50 mg/kg) for 10 days
Moderate to severe pneumonia (second line to ampicillin and gentamicin)
Adult: 1–2 g IV or deep IM injection daily in 1 or 2 divided dose for 7 days
Child: 50 mg/kg daily in 1 or 2 divided doses for 7 days
Neonate: 20–50 mg/kg daily in 1 or 2 divided doses (max 50 mg/kg) for 7 days
Abnormal vaginal/urethral discharge syndrome (in combination with metronidazole and doxycycline)
Adult: 1 g single dose by deep IM injection
Pelvic inflammatory disease; persistent urethral/vaginal discharge syndrome
Adult:1 g once daily by deep IM injection for 3 days
Severe gonococcal infection
Adult:1 g by deep IM injection once daily for 7 days
Gonococcal eye infection in new born infant (in combination with azithromycin)
25 mg/kg single dose by deep IM injection (max 125 mg)
Dysentery (second line for severely ill children)
50–80 mg/kg IV once daily for 3 days

Contraindications

  • Allergy to cephalosporin
  • Neonates with jaundice, low albumin levels, or acidosis

Side Effects

  • Stomach upset
  • Headache
  • Allergic reaction
  • Blood disorders

Interactions

  • Calcium or calcium-containing fluids (risk of calcium ceftriaxone deposits in urine and lungs; see caution)
  • Warfarin (increased anticoagulant effect)

Pregnancy

  • Can be used

Breastfeeding

  • Can be used

⚠️ Caution

  • Rapid injection can cause severe nausea and dizziness.
  • Give doses of >50 mg/kg in children and >1 g in adults by IV infusion
  • IM doses of >1 g should be divided over 2 injection sites
  • When used with calcium or calcium-containing fluids (e.g. Ringer’s Lactate), there is risk of calcium ceftriaxone deposits in urine and lungs. Higher risk in neonates dehydrated or immobilised patients.
  • Reduce dose in patients with severe kidney and liver disease
  • Ceftriaxone is second line to ampicillin and gentamicin in severe pneumonia
  • Avoid using ceftriaxone for indications not indicated or when first line medicines are available to avoid development of resistance
  • Give with caution in patients with penicillin sensitivity, may have cross-sensitivity