Pediatric Residents

Drug Name: Ceftriaxone

Click on the titles below for drug details

  • Third-generation cephalosporin
  • Binds penicillin-binding proteins
    • Impairs formation of the peptidoglycan layer of cell wall, which leads to cell death
  • Bactericidal.
  • Parenteral only (IV or IM)
    • IM ceftriaxone can be reconstituted with 1% lidocaine for analgesia
  • Doses
    • Common dosing: 50mg/kg/dose q24 hours (for less severe infections, including Community-acquired pneumonia, UTI, and bacteremia)
      • More frequent dosing (50 mg/kg/dose q12 hours) for infections requiring higher drug concentrations, such as meningitis and endocarditis
      • More frequent dosing can also be used for more severe focal infections (e.g., severe pneumonia)
    • Maximum dose: 2000 mg per DOSE, 4000 mg per DAY for severe infections
  • Spectrum:
    • Excellent coverage against S. pneumoniae
    • Broad Gram-negative coverage, including Neisseria species (meningiditis and gonorrheae), E. coli, Klebsiella, Proteus, Serratia, and Citrobacter
      • Note, some gram-negatives may develop Ceftriaxone-resistance (e.g., ESBL, AmpC-producing organisms)
    • Does NOT cover:
      • Pseudomonas, Methicillin-resistant Staphylococcus aureus, Enterococcus species.
    • Indications:
      • Often used as empiric treatment for respiratory infections, meningitis, and sepsis
      • Empyema or complicated parapneumonic effusions
        • May be used in typical community-acquired pneumonia, but PO Amoxicillin or IV Ampicillin should be considered given narrower spectrum of activity.
      • Acute Otitis Media - often used when adherence (e.g., inability to tolerate PO) is an issue. Additionally, typically requires only 1-3 doses.
      • Sexually-Transmitted Infections
        • Pelvic Inflammatory Disease, Epididymitis, Chancroid, Syphilis
      • Meningitis, empiric-treatment
      • Complicated bacterial enteritis, such as typhoid fever or shigellosis
      • Lyme Disease - often used for neurologic manifestations (e.g., Lyme meningitis), although doxycycline is often adequate treatment.
      • Urinary Tract Infections (e.g., Pyelonephritis), empiric treatment
      • Septic Arthritis, empiric treatment
  • Should not be administered to infants <44 weeks corrected gestational age, as there is a risk of displacement of bilirubin from albumin, increasing risk of kernicterus.
  • Cannot be administered with calcium-containing solutions (e.g., TPN, LR) - may cause insoluble precipitation of calcium in vasculature.
  • Hypersensitivity to cephalosporins
  • Allergic reactions
  • Increased risk of C. difficile infections
  • Diarrhea
  • Biliary sluding and stones
  • Prolonged-use or high doses have been associated with bone marrow suppression
  • Excellent distribution throughout the body, including the lungs, gallbladder, bone, and CSF (especially when meninges are inflamed)
  • May cause diarrhea; if severe diarrhea, bloody stools, and/or fever occur, discuss with your physician.