A nurse is preparing to administer the initial dose of ceftriaxone to a client who has endometriosis

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

• 1g/50mL
• 2g/50mL

powder for injection

• 250mg
• 500mg
• 1g
• 2g
• 10g
• 100g

Intra-abdominal Infections

Complicated, mild-to-moderate, community acquired: 1-2 g/day IV in single daily dose or divided q12hr for 4-7 days, in combination with metronidazole

Acute Bacterial Otitis Media

50 mg/kg IM once

Persistent or treatment failures: 50 mg/kg IV/IM for 3 days

Pelvic Inflammatory Disease

250 mg IM as single dose with doxycycline, with or without metronidazole for 14 days

Prosthetic Joint Infection

2 g IV q24hr for 2-6 weeks; continue treatment until clinical improvement observed and patient is afebrile for 48-72 hr

Meningitis

2 g IV q12hr for 7-14 days

Acute Uncomplicated Pyelonephritis

1-2 g IV qDay

Surgical Prophylaxis

Prophylaxis of surgical infection

1 g IV 0.5-2 hours before procedure

Uncomplicated Gonococcal Infections

Indicated for uncomplicated gonococcal infection of pharynx, cervix, urethra, or rectum

Weight 150 kg] IM once, PLUS

Septic/toxic Shock [Off-label]

2 g IV once daily; with clindamycin for toxic shock

Acute Epididymitis [Off-label]

Sexually transmitted chlamydia and gonorrhea

• Ceftriaxone 250 mg IM X 1 dose PLUS
• Doxycycline 100 mg PO BID for 10 days

Sexually transmitted chlamydia, gonorrhea, and enteric organisms

• Men who practice insertive anal sex
• Ceftriaxone 250 mg IM X 1 dose PLUS
• Levofloxacin 500 mg PO qDay for 10 days OR
• Ofloxacin 300 mg PO BID for 10 days

Enteric organisms

• Levofloxacin 500 mg PO qDay for 10 days OR
• Ofloxacin 300 mg PO BID for 10 days

Skin and Soft Necrotizing Infection [Off-label]

Due to Aeromonas hydrophilia: 1-2 g IV qDay in combination with doxycycline

Due to Vibrio vulnificus; 1 g IV qDay in combination with doxycycline

Continue treatment until further debridement not necessary, clinical improvement observed, and patient is afebrile for 48-72 hr

Severe Acute Bacterial Rhinosinusitis [Off-label]

Infection requiring hospitalization: 1-2 g IV q12-24hr for 5-7 days

Other Gonococcal Infections [Off-label]

Gonococcal conjunctivitis: 1 g IM once

Disseminated gonococcal infection: 1 g/day IV/IM; continued for at least 24-48 hours after improvement is observed, then continued with cefixime 400 mg PO q12hr to complete at least 1 week of therapy

Gonococcal endocarditis: 1-2 g IV q12hr for 4 weeks

Gonococcal meningitis: 1-2 g IV q12hr for 10-14 days

Acute epididymitis: 250 mg IM once with doxycycline

Dosing Considerations

Susceptible organisms

• Anaerobic cocci, Bacteroides fragilis, Borrelia burgdorferi, Clostridium spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Morganella morganii, Neisseria gonorrhoeae, Neisseria meningitidis, Proteus mirabilis, Providencia rettgeri, Pseudomonas spp, Serratia spp, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes

Dosage Forms & Strengths

injectable solution

• 1g/50mL
• 2g/50mL

powder for injection

• 250mg
• 500mg
• 1g
• 2g

Acute Bacterial Otitis Media

50 mg/kg IM in single dose; not to exceed 1 g  

Epiglottis [Off-label]

100 mg/kg/day IV on first day; follow with 50 mg/kg on day 2 or 75 mg/kg qDay for 10-14 days

Meningitis

100 mg/kg/day IV/IM in single daily dose or divided q12hr for 7-14 days; not to exceed 4 g/day  

Serious Infections Other Than Meningitis

50-75 mg/kg/day IV/IM divided q12hr for 7-14 days  

Skin/Skin Structure Infections

>12 years: 1-2 g/day IV/IM in single daily dose or divided q12hr for 7-14 days, depending on type and severity of infection

Gonococcal Infections

Neonates

• Ophthalmia neonatorum: 25-50 mg/kg IV/IM once; not to exceed 125 mg  
• Disseminated gonococcal infections and gonococcal scalp abscesses: 25-50 mg/kg/day IV/IM in single daily dose for 7 days; if meningitis is documented, treat for 10-14 days
• Prophylaxis for infants of mothers with gonococcal infection: 25-50 mg/kg IV/IM once; not to exceed 125 mg

Children

• 45 kg: 1-2 g IV q12hr

Interactions

Interaction Checker

Enter a drug name and ceftriaxone

No Interactions Found

Interactions Found

Contraindicated

Serious - Use Alternative

Significant - Monitor Closely

Minor

All Interactions Sort By:

Contraindicated [5]

• calcium acetate

  ceftriaxone, calcium acetate. Other [see comment]. Contraindicated. Comment: Do not use ANY calcium containing solutions [including Ringer or Harmann solutions] in combination with IV ceftriaxone; risk of potentially fatal particulate precipitation in lungs, kidneys. Separate administration by at least 48 hrs.

• calcium carbonate

  ceftriaxone, calcium carbonate. Other [see comment]. Contraindicated. Comment: Do not use ANY calcium containing solutions [including Ringer or Harmann solutions] in combination with IV ceftriaxone; risk of potentially fatal particulate precipitation in lungs, kidneys. Separate by at least 48 hrs.

• calcium chloride

  ceftriaxone, calcium chloride. Other [see comment]. Contraindicated. Comment: 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 and calcium. Separate IV ceftriaxone and IV calcium by at least 48 hrs. However, in patients other than neonates, ceftriaxone and calcium containing solutions may be administered sequentially of one another if the IV infusion lines are thoroughly flushed between infusions with a compatible fluid.

• calcium citrate

  ceftriaxone, calcium citrate. Other [see comment]. Contraindicated. Comment: Do not use ANY calcium containing solutions [including Ringer or Harmann] in combination with IV ceftriaxone; risk of potentially fatal particulate precipitation in lungs, kidneys. Separate by at least 48 hrs.

• calcium gluconate

  ceftriaxone, calcium gluconate. Other [see comment]. Contraindicated. Comment: Do not use ANY calcium containing solutions [including Ringer or Harmann] in combination with IV ceftriaxone; risk of potentially fatal particulate precipitation in lungs, kidneys. Separate by at least 48 hrs.

Serious - Use Alternative [9]

• argatroban

  ceftriaxone will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

• BCG vaccine live

  ceftriaxone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

• bivalirudin

  ceftriaxone will increase the level or effect of bivalirudin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

• cholera vaccine

  ceftriaxone, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

• dalteparin

  ceftriaxone increases effects of dalteparin by anticoagulation. Avoid or Use Alternate Drug. Cephalosporins may decrease prothrombin activity.

• enoxaparin

  ceftriaxone increases effects of enoxaparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

• fondaparinux

  ceftriaxone increases effects of fondaparinux by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

• heparin

  ceftriaxone will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

• typhoid vaccine live

  ceftriaxone decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

Monitor Closely [15]

• bazedoxifene/conjugated estrogens

  ceftriaxone will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

• chloramphenicol

  chloramphenicol decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• demeclocycline

  demeclocycline decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• dienogest/estradiol valerate

  ceftriaxone will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

• doxycycline

  doxycycline decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• erythromycin base

  erythromycin base decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• erythromycin lactobionate

  erythromycin lactobionate decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• erythromycin stearate

  erythromycin stearate decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• minocycline

  minocycline decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• probenecid

  probenecid will increase the level or effect of ceftriaxone by acidic [anionic] drug competition for renal tubular clearance. Use Caution/Monitor.

• sodium picosulfate/magnesium oxide/anhydrous citric acid

  ceftriaxone decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

• tetracycline

  tetracycline decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• voclosporin

  voclosporin, ceftriaxone. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

• warfarin

  ceftriaxone increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.

Minor [4]

• choline magnesium trisalicylate

  ceftriaxone will increase the level or effect of choline magnesium trisalicylate by acidic [anionic] drug competition for renal tubular clearance. Minor/Significance Unknown.

• furosemide

  ceftriaxone increases toxicity of furosemide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of nephrotoxicity.

• rose hips

  rose hips will increase the level or effect of ceftriaxone by acidic [anionic] drug competition for renal tubular clearance. Minor/Significance Unknown.

• willow bark

  ceftriaxone will increase the level or effect of willow bark by acidic [anionic] drug competition for renal tubular clearance. Minor/Significance Unknown.

Adverse Effects

>10%

Induration after IM injection [5-17%]

1-10%

Eosinophilia [6%]

Thrombocytosis [5%]

Diarrhea [3%]

Elevated hepatic transaminases [3%]

Leukopenia [2%]

Rash [2%]

Increased blood urea nitrogen [BUN] [1%]

Induration at IV site [1%]

Pain [1%]