From the Guidelines
Ceftriaxone is recommended as an empirical treatment for complicated urinary tract infections (UTIs) with systemic symptoms, particularly when oral antibiotics have failed or are not suitable, as stated in the 2024 European Association of Urology guidelines 1. The typical dosage of ceftriaxone for UTIs is 1-2 grams administered intravenously or intramuscularly once daily for 7-14 days, depending on infection severity. Some key points to consider when using ceftriaxone for UTIs include:
- Ceftriaxone is a third-generation cephalosporin that works by inhibiting bacterial cell wall synthesis and is effective against many gram-negative bacteria commonly causing UTIs, including Escherichia coli.
- It is particularly useful for infections caused by resistant organisms or when oral antibiotics have failed.
- Patients should complete the full course of treatment even if symptoms improve quickly to prevent recurrence and antibiotic resistance.
- Common side effects include diarrhea, nausea, and pain at the injection site.
- Patients with a history of severe penicillin allergy should use ceftriaxone cautiously due to potential cross-reactivity. According to the European Association of Urology guidelines, ceftriaxone can be used as part of a combination therapy for complicated UTIs, including a combination with an aminoglycoside or as a single agent for empirical treatment 1. Additionally, the guidelines recommend managing any urological abnormality and/or underlying complicating factors, and using ceftriaxone only when the local resistance rate is low and the patient does not require hospitalization 1. It's also important to note that ceftriaxone is not typically used as first-line therapy for uncomplicated UTIs because it requires injection and is generally reserved for hospitalized patients or those needing parenteral therapy, as stated in the 2011 international clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women 1. However, the 2019 AUA/CUA/SUFU guideline recommends using first-line therapy, such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, dependent on the local antibiogram for the treatment of symptomatic UTIs in women 1. In summary, ceftriaxone is a effective antibiotic for treating complicated UTIs, particularly when oral antibiotics have failed or are not suitable, and should be used in accordance with the European Association of Urology guidelines and the patient's individual needs.
From the FDA Drug Label
URINARY TRACT INFECTIONS (complicated and uncomplicated) Caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae Ceftriaxone is indicated for the treatment of urinary tract infections (UTIs), including both complicated and uncomplicated cases, caused by susceptible organisms such as:
- Escherichia coli
- Proteus mirabilis
- Proteus vulgaris
- Morganella morganii
- Klebsiella pneumoniae 2
From the Research
Ceftriaxone for UTI Treatment
- Ceftriaxone is a cephalosporin antibiotic that has been studied for the treatment of complicated urinary tract infections (UTIs) 3, 4.
- Two studies compared the efficacy of ceftriaxone with ertapenem, another antibiotic, for the treatment of complicated UTIs, and found that the two treatments had equivalent outcomes 3, 4.
- The most common pathogens in these studies were Escherichia coli and Klebsiella pneumoniae, and the majority of patients were switched to oral therapy after a minimum of 3 days of intravenous treatment 3, 4.
Comparison with Other Antibiotics
- A study compared ceftriaxone with co-amoxiclav+gentamicin for the treatment of complicated UTIs, and found that ceftriaxone was associated with a longer length of stay, higher occurrence of complications, and higher rate of urinary tract re-infections, particularly with Enterococcus spp. 5.
- Another study compared cefdinir, a cephalosporin antibiotic, with cephalexin for the treatment of UTIs, and found that the two agents had comparable efficacy, although cefdinir had a numerically higher rate of treatment failure 6.
Considerations for Ceftriaxone Use
- Ceftriaxone therapy should be considered carefully in patients with complicated UTIs due to the possibility of enterococcal re-infection and consequent prolonged hospital stay 5.
- The use of ceftriaxone for UTI treatment may be influenced by factors such as patient demographics, medical history, and local resistance patterns 7.