From the FDA Drug Label
Ceftriaxone for injection should be administered intravenously by infusion over a period of 30 minutes, except in neonates where administration over 60 minutes is recommended to reduce the risk of bilirubin encephalopathy. The rate to infuse ceftriaxone 2g IV is over a period of 30 minutes 1.
From the Research
Ceftriaxone 2g IV should be infused over 30 minutes. To prepare the infusion, reconstitute the ceftriaxone powder with an appropriate diluent (typically 50-100 mL of compatible IV fluid such as normal saline or D5W) and administer through a controlled infusion device. The 30-minute infusion time is important to minimize vein irritation while ensuring therapeutic drug levels. Administering too rapidly may increase the risk of adverse effects such as pain at the injection site or, rarely, more serious reactions. For patients with fluid restrictions, a minimum volume of 50 mL can be used, while standard practice often utilizes 100 mL. Ensure the IV line is patent before starting the infusion and monitor the site during administration for signs of phlebitis or extravasation. After completion, flush the line with compatible solution to ensure the full dose is delivered.
According to the most recent study 2, the safety and efficacy of intravenous push and intravenous piggyback ceftriaxone in critically ill patients were compared, and it was found that intravenous piggyback ceftriaxone was associated with lower treatment failure and hospital mortality. Although this study does not directly address the infusion rate, it highlights the importance of careful administration of ceftriaxone to minimize adverse effects.
Other studies 3, 4, 5, 6 provide information on the pharmacodynamics, efficacy, and safety of ceftriaxone, as well as the risk of infusion phlebitis associated with peripheral intravenous catheters. However, the most recent and highest-quality study 2 supports the recommendation for a 30-minute infusion time to minimize vein irritation and ensure therapeutic drug levels.
Key considerations for infusion include:
- Using a compatible IV fluid and diluent
- Administering through a controlled infusion device
- Monitoring the IV site for signs of phlebitis or extravasation
- Flushing the line with compatible solution after completion
- Considering patient-specific factors, such as fluid restrictions and vein integrity.