Cephalosporins · Anti-infectives
Ceftriaxone
Rocephin®(brand names vary by market)
Once a day, into the CSF, and hard on the gut flora.
Also: infusion
Mechanism
Third-generation cephalosporin with extended Gram-negative coverage and enough CNS penetration to treat meningitis.
Indications
- Community-acquired pneumonia
- Pyelonephritis
- Meningitis
- Gonorrhoea
- Spontaneous bacterial peritonitis
- Septic arthritis
Formulations
Dosing concepts
Once daily
Its long half-life allows once-daily dosing, which is what makes outpatient parenteral therapy practical.
Meningitis doses
CNS infection needs substantially higher doses than pneumonia, because penetration across an inflamed but still selective barrier is incomplete.
Renal impairment
Largely biliary, so it is one of the few antibiotics needing little renal adjustment.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- Parenteral only
- Half-life
- 6 to 9 h
- Elimination
- mixed: Substantial biliary excretion, which is why renal dosing is rarely needed
- Protein binding
- ~95%
Adverse effects
- Diarrhoea and C. difficilecommon & seriousBroad Gram-negative coverage means substantial collateral damage to gut flora.
- Rashcommon
- Biliary pseudolithiasisseriousPrecipitates in bile as calcium salts; usually asymptomatic and reversible.
- Hemolytic anemiaseriousRare and immune-mediated.
Contraindications & precautions
Contraindications
- Prior severe cephalosporin hypersensitivity
- Neonates receiving calcium-containing intravenous fluids
- Neonatal hyperbilirubinemia
Precautions
- Prior C. difficile
- Concurrent calcium-containing infusions through the same line
Interactions
Monitoring
Clinical response and de-escalation opportunity
Broad therapy should narrow once cultures return; that is the whole of stewardship in one habit
Diarrhoea
C. difficile risk is meaningful with this agent
Counselling points
- Given by injection, usually once daily.
- Report diarrhoea, especially if severe or bloody.
- Tell us about any previous reaction to penicillins or cephalosporins.
Clinical pearls
- It covers neither enterococci nor Pseudomonas. A patient failing on ceftriaxone frequently has one of those two.
- Because it needs little renal adjustment and is given once daily, it is the backbone of outpatient intravenous antibiotic programmes.
References & review
- Ceftriaxone product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.