Is ceftriaxone (a third-generation cephalosporin antibiotic) okay to use?

Ceftriaxone Safety and Efficacy

Ceftriaxone is a safe and effective third-generation cephalosporin antibiotic that can be used for a wide range of bacterial infections with an excellent safety profile. 1

Indications and Efficacy

• Ceftriaxone is FDA-approved for multiple infections including lower respiratory tract infections, acute bacterial otitis media, skin and skin structure infections, urinary tract infections, uncomplicated gonorrhea, pelvic inflammatory disease, bacterial septicemia, bone and joint infections, intra-abdominal infections, and meningitis 1
• It provides sustained, high bactericidal levels in the blood with a single injection of 125 mg, curing 98.9% of uncomplicated urogenital and anorectal gonococcal infections 2
• For gonorrhea, ceftriaxone 125 mg IM in a single dose is a recommended regimen, especially for infections in men who have sex with men (MSM) or in those with a history of recent foreign travel 2
• Ceftriaxone has demonstrated efficacy rates exceeding 90% in treating serious bacterial infections in both adults and children 3, 4

Pharmacological Advantages

• Ceftriaxone has an exceptionally long serum half-life of 5.8-8.7 hours (mean 6.5 hours), allowing for once-daily dosing in most adults and every 12 hours in children 3, 5
• It distributes well throughout body tissues, including penetration into cerebrospinal fluid in the presence of inflammation 3
• The drug demonstrates excellent activity against many gram-negative aerobic bacilli and outstanding bactericidal action against pneumococci, group B streptococci, meningococci, gonococci, and Haemophilus influenzae 3

Safety Considerations

• Dosage modification is generally only necessary when there is combined hepatic and renal dysfunction 3
• Monitor prothrombin time during treatment in patients with impaired vitamin K synthesis or low vitamin K stores (e.g., chronic hepatic disease and malnutrition) 1
• Be aware of potential ceftriaxone-calcium precipitates in the gallbladder (pseudolithiasis) and urinary tract (urolithiasis), particularly in pediatric patients 1
• Cases of pancreatitis, possibly secondary to biliary obstruction, have been reported, especially in patients with risk factors for biliary stasis and biliary sludge 1

Special Populations

Pediatric Use

• Ceftriaxone is approved for all gonococcal infections in children 2
• For children weighing <45 kg with uncomplicated gonococcal infections, the recommended dose is 125 mg IM in a single dose 2
• For children weighing <45 kg with bacteremia or arthritis, the recommended dose is 50 mg/kg (maximum 1 g) IM or IV daily for 7 days 2
• Ceftriaxone should not be administered to hyperbilirubinemic neonates, especially prematures 1

Pregnancy and Nursing

• Reproductive studies have shown no evidence of embryotoxicity, fetotoxicity, or teratogenicity at doses up to 20 times the usual human dose 1
• Low concentrations of ceftriaxone are excreted in human milk; caution should be exercised when administered to nursing women 1

Common Pitfalls and Caveats

• While ceftriaxone has some activity against Pseudomonas aeruginosa, it should not be used as sole antibiotic therapy for pseudomonal infections 6
• When treating pelvic inflammatory disease caused by Neisseria gonorrhoeae, remember that ceftriaxone has no activity against Chlamydia trachomatis, so appropriate antichlamydial coverage should be added 1
• Ensure adequate hydration in patients receiving ceftriaxone to prevent urolithiasis 1
• Discontinue ceftriaxone in patients who develop signs and symptoms suggestive of gallbladder disease or urolithiasis 1

Ceftriaxone's long half-life, broad-spectrum activity, and excellent safety profile make it a valuable antibiotic for treating a wide range of bacterial infections, with the convenience of once-daily dosing in most cases.