Section 15 · Monograph
Ceftriaxone
Reviewed Nov 2026FDA label
RocephinCephalosporin (3rd gen)
- Forms
- IV/IM: 250mg, 500mg, 1g, 2g vials
- Dose
- Bacterial meningitis: 2g IV q12h
- MOA
- Inhibits bacterial cell wall synthesis
Indications
- Bacterial meningitis (S. pneumoniae, N. meningitidis, H. influenzae)FDA-labeled
- Many other serious bacterial infections (respiratory, skin, urinary, intra-abdominal, bone/joint, gonorrhea)FDA-labeled
Off-Label Uses
- Lyme neuroborreliosis (2g IV daily)Off-label
- Alternative for neurosyphilisOff-label
Mechanism of Action
- Third-generation cephalosporin that inhibits bacterial cell wall synthesis; good CSF penetration with inflamed meninges
Full Dosing
Adult / usual
- Do not mix or co-infuse with calcium-containing solutions
Pediatric
- Meningitis: 2g IV every 12 hours (adults); pediatric 100mg/kg/day divided every 12 hours (max 4g/day)
Contraindications
- Hypersensitivity to ceftriaxone or other cephalosporins
- Hyperbilirubinemic or premature neonates (bilirubin displacement)
- Neonates receiving calcium-containing IV solutions
Drug Interactions
- Calcium-containing IV products: ceftriaxone-calcium precipitation
- May potentiate warfarin effect
Adverse Effects
- Diarrhea, C. difficile infection
- Biliary pseudolithiasis and sludge
- Hypersensitivity and anaphylaxis
- Hemolytic anemia (rare)
- Encephalopathy in renal impairment (rare)
Monitoring Parameters
- CBC, renal and hepatic function with prolonged therapy
- Clinical response
Pregnancy & Lactation
- Generally considered acceptable in pregnancy
- Low concentrations in milk; considered compatible