Ceftriaxone for Bacterial Infections
Ceftriaxone is highly effective for treating a wide range of bacterial infections, with extensive clinical experience showing it provides sustained, high bactericidal levels in the blood and cures 98.9% of uncomplicated urogenital and anorectal infections. 1
Indications and Efficacy
Ceftriaxone is a third-generation cephalosporin with broad-spectrum activity against many bacterial pathogens:
- Urogenital/anorectal infections: 98.9% cure rate in clinical trials 1
- Sexually transmitted infections: Recommended first-line therapy for gonorrhea 1
- Respiratory tract infections: Effective for pneumonia and other respiratory infections 2, 3
- Urinary tract infections: Achieves very high levels in urine and surrounding tissues 4
- Skin/soft tissue infections: 91% response rate in serious infections 2
- Bacteremia/septicemia: Effective in treating bloodstream infections 2, 3
Dosing Recommendations
The dosing depends on the type and severity of infection:
- Gonococcal infections: 125-250 mg IM single dose (older guidelines) 1; more recent guidelines recommend 1 g IM/IV single dose 1
- Serious bacterial infections: 1-2 g IV/IM daily or divided every 12 hours 2, 5
- No dose adjustment needed for renal insufficiency when using doses of 2 g or less per day 6
Administration Routes
- Intramuscular (IM): Single injection provides sustained bactericidal levels
- Intravenous (IV): For more serious infections
- Note: Unlike oral cephalosporins (cefixime, etc.), ceftriaxone must be administered parenterally 1
Special Populations
- Renal insufficiency: No dose adjustment required for doses ≤2 g daily 6
- Hemodialysis patients: Administer after dialysis session 6
- Cirrhotic patients: Good response (90%) seen in bacterial infections 3
- Pregnant women: No evidence of embryotoxicity or teratogenicity in animal studies 7
Antimicrobial Spectrum
Ceftriaxone is active against:
- Gram-positive bacteria (though less active than first-generation cephalosporins) 8
- Gram-negative bacteria (more active than first/second-generation cephalosporins) 8
- Some anaerobic bacteria 8, 2
Potential Adverse Effects
- Gallbladder pseudolithiasis: Ceftriaxone-calcium precipitates may form in the gallbladder 7
- Urolithiasis: Precipitates may form in the urinary tract 7
- Bleeding risk: Monitor prothrombin time in patients with impaired vitamin K synthesis 7
- Pancreatitis: Rare cases reported, possibly secondary to biliary obstruction 7
Clinical Pearls and Caveats
For gonorrhea treatment: Current European guidelines recommend higher doses (1 g) than older CDC guidelines (125 mg) 1
Resistance concerns: Surveillance for antimicrobial resistance is crucial, especially for gonorrhea 1
Pharyngeal infections: Ceftriaxone is more effective than oral cephalosporins for pharyngeal gonorrhea 1
Co-treatment for chlamydia: When treating gonorrhea, add treatment for chlamydia if not ruled out 1
Avoid in hyperbilirubinemic neonates: Can displace bilirubin from serum albumin 7
Ceftriaxone's long half-life allows for once-daily dosing in most infections, providing convenience and potential cost benefits while maintaining excellent efficacy against a wide range of bacterial pathogens 8.