What organisms causing diarrhea is ceftriaxone (Inj ceftriaxone) effective against?

Ceftriaxone's Effectiveness Against Diarrhea-Causing Organisms

Injectable ceftriaxone is effective against several bacterial pathogens causing diarrhea, particularly nontyphoidal Salmonella, Shigella, and Yersinia species, especially in cases of bacteremia or severe infection. 1

Bacterial Pathogens Effectively Treated with Ceftriaxone

Salmonella Species

• Ceftriaxone (2g IV daily) plus ciprofloxacin is recommended for bacteremia caused by nontyphoidal Salmonella species 1
• Ceftriaxone has demonstrated efficacy in eradicating Salmonella from feces more effectively than supportive care alone 2
• Particularly useful for multidrug-resistant Enterobacteriaceae including resistant Salmonella strains 3

Shigella Species

• Ceftriaxone has shown superior efficacy compared to ampicillin for severe shigellosis, with faster resolution of diarrhea (2.5 days vs 6.8 days) and better bacterial clearance (100% vs 60%) 4
• Recommended as part of empiric therapy for severe bloody diarrhea in immunocompromised patients 1
• All Shigella isolates in clinical studies have shown susceptibility to ceftriaxone, even when resistant to other antibiotics 4

Yersinia Species

• For Yersinia bacteremia, ceftriaxone (2g IV daily) plus gentamicin (5 mg/kg IV daily) is the recommended treatment 1
• For diarrhea caused by Yersinia, fluoroquinolones are first-line, but ceftriaxone may be used in severe cases or bacteremia 1

Clinical Considerations and Limitations

Advantages of Ceftriaxone

• Long elimination half-life allows for once-daily dosing, which can result in cost savings 5
• Effective against multidrug-resistant strains of enteric pathogens 3
• Particularly valuable for severe infections or in immunocompromised hosts 1

Resistance Concerns

• Emerging resistance to ceftriaxone has been reported in some Shigella and nontyphoidal Salmonella strains globally 6
• Some strains with co-resistance to ciprofloxacin, azithromycin, and ceftriaxone have emerged worldwide 6
• Treatment decisions should consider local resistance patterns 7

When to Use Ceftriaxone for Diarrhea

• Empiric antibacterial treatment with ceftriaxone should be considered in:
  • Immunocompromised patients with severe illness and bloody diarrhea 1
  • Infants under 3 months of age with suspected bacterial diarrhea 1
  • Patients with signs of sepsis or bacteremia 1
• Not recommended for routine, uncomplicated diarrhea in immunocompetent adults 1

Organisms NOT Effectively Treated with Ceftriaxone

• Viral causes of diarrhea (norovirus, rotavirus, adenovirus) do not respond to ceftriaxone 1
• Limited activity against Pseudomonas aeruginosa - not recommended as monotherapy for pseudomonal infections 3
• Not effective against parasitic causes of diarrhea such as Giardia, Cryptosporidium, or Cyclospora 1

For Campylobacter species, azithromycin is preferred as first-line therapy, with fluoroquinolones as alternatives due to high fluoroquinolone resistance rates (19%); ceftriaxone is not specifically recommended for Campylobacter diarrhea 1.