Does Rocephin (Ceftriaxone) cover Gram-negative rods?

From the Guidelines

Rocephin (ceftriaxone) is effective against many gram-negative rods, but its use should be guided by local resistance patterns and the specific clinical context. As a third-generation cephalosporin, it has excellent activity against common gram-negative pathogens including Escherichia coli, Klebsiella pneumoniae, Proteus species, Haemophilus influenzae, Neisseria gonorrhoeae, and many Enterobacteriaceae 1. The typical adult dose is 1-2 grams intravenously or intramuscularly once daily, with treatment duration varying based on the infection type. However, it has limited activity against Pseudomonas aeruginosa and is not effective against extended-spectrum beta-lactamase (ESBL) producing organisms or carbapenem-resistant Enterobacteriaceae. For these resistant organisms, alternative antibiotics like carbapenems, aminoglycosides, or polymyxins may be necessary.

Some key points to consider when using Rocephin include:

• Its effectiveness against gram-negative rods, including many Enterobacteriaceae 1
• Its limited activity against Pseudomonas aeruginosa and ESBL-producing organisms 1
• The importance of guiding its use by local resistance patterns and the specific clinical context 1
• The need for alternative antibiotics for resistant organisms, such as carbapenems, aminoglycosides, or polymyxins 1

It's also important to note that Rocephin provides coverage against many gram-positive organisms, making it a versatile choice for empiric therapy in many infections. However, its use should always be guided by the principles of antimicrobial stewardship, including the selection of the most appropriate antibiotic for the specific infection, and the use of the minimum effective dose and duration of therapy to minimize the risk of resistance and adverse effects 1.

From the FDA Drug Label

Ceftriaxone has activity in the presence of some beta-lactamases, both penicillinases and cephalosporinases, of Gram-negative and Gram-positive bacteria. The following bacteria... Gram-negative bacteria Acinetobacter calcoaceticusEnterobacter aerogenesEnterobacter cloacaeEscherichia coliHaemophilus influenzaeHaemophilus parainfluenzaeKlebsiella oxytocaKlebsiella pneumoniaeMoraxella catarrhalisMorganella morganiiNeisseria gonorrhoeaeNeisseria meningitidisProteus mirabilisProteus vulgarisPseudomonas aeruginosaSerratia marcescens

Rocephin (ceftriaxone) covers Gram-negative rods, including:

• Enterobacter species
• Escherichia coli
• Klebsiella species
• Proteus species
• Serratia marcescens 2

From the Research

Rocephin Coverage of Gram-Negative Rods

• Rocephin, also known as ceftriaxone, is a third-generation cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative aerobic, and some anaerobic, bacteria 3.
• It has excellent activity against many Gram-negative aerobic bacilli, including Escherichia coli, species of Proteus, Klebsiella, Morganella, Providencia, and Citrobacter, and Enterobacter agglomerans 4.
• Ceftriaxone is effective in treating infections due to multidrug-resistant Enterobacteriaceae, which are Gram-negative rods 3.
• However, ceftriaxone has limited activity against Pseudomonas aeruginosa, a type of Gram-negative rod, and is not recommended as sole antibiotic therapy in pseudomonal infections 3.
• The efficacy of ceftriaxone against ceftriaxone-resistant Gram-negative bacilli, including those caused by extended-spectrum beta-lactamase (ESBL) or AmpC-producing Enterobacteriaceae, is a concern, and carbapenems are often considered the treatment of choice for these infections 5.

Specific Gram-Negative Rods Covered by Rocephin

• Escherichia coli: ceftriaxone has excellent activity against E. coli 4.
• Klebsiella: ceftriaxone has excellent activity against Klebsiella species 4.
• Enterobacter: ceftriaxone has excellent activity against Enterobacter species, including Enterobacter agglomerans 4.
• Pseudomonas aeruginosa: ceftriaxone has limited activity against P. aeruginosa and is not recommended as sole antibiotic therapy in pseudomonal infections 3.

Clinical Use of Rocephin for Gram-Negative Rod Infections

• Ceftriaxone has been used to treat various infections caused by Gram-negative rods, including urinary tract infections, lower respiratory tract infections, skin and soft tissue infections, and bacteremia 3, 4.
• The dosage of ceftriaxone for treating Gram-negative rod infections is typically 1-2 grams once daily, although the optimal dose is still being studied 6.