From the Guidelines
Ceftriaxone is recommended as an initial intravenous dose for the treatment of urinary tract infections (UTIs) when the susceptibility of the uropathogen is not known, particularly at a dose of 1 g 1. This recommendation is based on guidelines from the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. The use of ceftriaxone in UTIs is generally reserved for complicated infections or when oral antibiotics are not appropriate.
Key Points to Consider
- Ceftriaxone is a third-generation cephalosporin antibiotic effective against many gram-negative bacteria commonly causing UTIs.
- It achieves high concentrations in the urinary tract and has a long half-life, allowing for once-daily dosing 1.
- Patients receiving ceftriaxone should be monitored for side effects, including diarrhea, allergic reactions, and potential biliary sludging with prolonged use.
- Urine cultures should be obtained before starting therapy whenever possible to ensure appropriate antibiotic selection.
Treatment Considerations
- For uncomplicated UTIs, oral antibiotics like nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin are typically the first line of treatment 1.
- Ceftriaxone is considered for more severe infections, hospitalized patients, or cases where resistance to first-line antibiotics is suspected.
- The typical dose of ceftriaxone for UTIs is 1-2 grams administered intravenously or intramuscularly once daily for 7-14 days, depending on infection severity 1.
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
Role of Ceftriaxone in Treating UTIs
- Ceftriaxone is a third-generation cephalosporin used to treat various infections, including urinary tract infections (UTIs) 3, 4, 5, 6.
- The efficacy of ceftriaxone in treating UTIs has been compared to other antibiotics, such as ertapenem, in several studies 3, 6.
- These studies have shown that ceftriaxone is effective in treating complicated UTIs, with similar success rates to ertapenem 3, 6.
Comparison with Other Antibiotics
- Ceftriaxone has been compared to cefazolin, a first-generation cephalosporin, in terms of susceptibility to Enterobacterales urinary isolates 4.
- The study found that cefazolin exhibited high susceptibility to uropathogens commonly implicated in uncomplicated UTIs, although ceftriaxone showed a higher susceptibility rate against these pathogens 4.
- However, ceftriaxone was associated with a higher risk of hospital-onset Clostridioides difficile infection (HOCDI) compared to cefazolin 4.
Risks and Complications
- Ceftriaxone therapy has been associated with a higher risk of enterococcal re-infection and prolonged hospitalization in patients with complicated UTIs 5.
- The study found that patients treated with ceftriaxone had significantly longer lengths of stay and higher occurrence of complications, including re-infections of the urinary tract, compared to those treated with co-amoxiclav+gentamicin 5.
Historical Context
- The treatment of UTIs has evolved over time, with various antibiotics being used to treat these infections 7.
- Sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid were commonly used to treat UTIs in the past, but their use has decreased with the development of newer antibiotics 7.