Ceftriaxone Safety in Pregnancy
Ceftriaxone is safe to use during pregnancy and is considered an appropriate antibiotic choice for treating susceptible infections in pregnant women. 1, 2
Evidence Supporting Safety
The FDA drug label for ceftriaxone specifically addresses pregnancy safety, stating:
- Reproductive studies in mice and rats at doses up to 20 times the usual human dose showed no evidence of embryotoxicity, fetotoxicity, or teratogenicity 1
- Primate studies at approximately 3 times the human dose demonstrated no embryotoxicity or teratogenicity 1
- While there are no adequate and well-controlled studies in pregnant women, animal reproductive studies support safety 1
The 2025 Praxis Medical Insights summary of clinical guidelines confirms that ceftriaxone is recommended by multiple authoritative sources for treating various infections during pregnancy, including:
- Salmonella gastroenteritis (American Family Physician and CDC) 2
- Syphilis in penicillin-allergic patients (CDC) 2
- Gonorrhea during pregnancy 2
Pharmacokinetics During Pregnancy
Research on ceftriaxone pharmacokinetics during pregnancy shows:
- No accumulation of the drug during treatment 3
- Pharmacokinetic parameters in pregnant women during the third trimester are similar to those in non-pregnant individuals 3
- No dosage adjustments are needed during pregnancy for the standard 2g daily dose 3, 4
- Residual concentrations at 24 hours remain above MICs for susceptible organisms 3
Clinical Applications
Ceftriaxone has been successfully used to treat various infections during pregnancy:
- For early syphilis in penicillin-allergic pregnant women (250 mg IM daily for 7-10 days), with successful outcomes for both mothers and neonates 5
- For gonococcal infections in pregnancy, with 95% efficacy (125 mg IM) 6
- For perinatal infections including chorioamnionitis, intrauterine infections, and pyelonephritis 7, 4
Administration Considerations
- Standard dosing regimens can be used during pregnancy without adjustment 2, 3
- For gonorrhea in pregnancy, the CDC recommends 125 mg IM as an effective dose 6
- For syphilis in penicillin-allergic pregnant women, ceftriaxone is an alternative treatment option 8, 2
Monitoring and Precautions
- As with any cephalosporin, monitor for hypersensitivity reactions 2
- While ceftriaxone crosses the placenta, studies have shown no adverse effects on the fetus 2, 1
- The Mayo Clinic Proceedings (2025) notes that ceftriaxone provides reliable coverage for gram-positive, gram-negative, and anaerobic bacteria with a favorable adverse effect profile 8
Conclusion
Ceftriaxone is well-established as a safe antibiotic option during pregnancy based on both animal studies and clinical experience. Its pharmacokinetic profile remains stable during pregnancy, and no dosage adjustments are typically needed. When treating susceptible infections in pregnant women, ceftriaxone can be confidently used as either a first-line agent or an alternative for penicillin-allergic patients.