Safety of Ceftriaxone During Pregnancy
Ceftriaxone is safe to use during pregnancy and is considered one of the preferred parenteral antibiotics for treating infections in pregnant women.
Evidence Supporting Safety in Pregnancy
Ceftriaxone belongs to the cephalosporin class of antibiotics, which are generally considered safe during pregnancy. According to the FDA drug label, reproductive studies have been performed in mice and rats at doses up to 20 times the usual human dose and have shown no evidence of embryotoxicity, fetotoxicity, or teratogenicity 1.
The Infectious Diseases Society of America guidelines specifically mention that pregnant or lactating patients may be treated in a fashion identical to nonpregnant patients with the same disease manifestation, except that doxycycline should be avoided 2.
Pharmacokinetics During Pregnancy
Research on ceftriaxone pharmacokinetics during pregnancy has shown:
- No accumulation of ceftriaxone during treatment
- Pharmacokinetic parameters in pregnant women during the third trimester are similar to those in non-pregnant individuals
- Residual concentrations remain above MICs for susceptible organisms at 24 hours 3
Clinical Applications in Pregnancy
Ceftriaxone is recommended for various infections during pregnancy:
- It is listed as a preferred parenteral regimen for Lyme disease at a dose of 2g intravenously once per day 2
- The Mayo Clinic Proceedings (2025) identifies ceftriaxone as a reliable coverage option for gram-positive, gram-negative, and anaerobic bacteria during pregnancy 2
- It has been successfully used as an alternative treatment for early syphilis in pregnant women with penicillin allergy 4
Dosing Considerations
Standard dosing of ceftriaxone can be used during pregnancy:
- For most infections: 1-2g IV/IM daily
- For severe infections: Up to 4g daily divided into 1-2 doses
- No dosage adjustment is required specifically for pregnancy 3
Advantages Over Other Antibiotics
Ceftriaxone offers several advantages during pregnancy:
- Unlike tetracyclines (including doxycycline), it doesn't cause tooth discoloration or bone growth inhibition in the fetus 2
- Unlike fluoroquinolones, it doesn't pose risks of cartilage damage 2
- Unlike trimethoprim-sulfamethoxazole, it's not associated with increased risk of birth defects 2
Safety for Breastfeeding
Low concentrations of ceftriaxone are excreted in human milk. Caution should be exercised when ceftriaxone is administered to a nursing woman, but it is generally considered compatible with breastfeeding 1.
Potential Concerns and Monitoring
While generally safe, monitoring should include:
- Liver function tests (transient elevations in GOT, GPT, and Al-P have been reported) 5
- Allergic reactions (especially in patients with penicillin allergy, though cross-reactivity is minimal with third-generation cephalosporins) 2
Conclusion
Based on the most recent and highest quality evidence, ceftriaxone is a safe and effective antibiotic option during pregnancy. Its favorable safety profile, broad antimicrobial coverage, and established efficacy make it an appropriate choice when parenteral antibiotic therapy is indicated during pregnancy.