What does IM (Intramuscular) Rocephin (Ceftriaxone) treat?

What IM Rocephin (Ceftriaxone) Treats

IM ceftriaxone is a broad-spectrum third-generation cephalosporin used to treat serious bacterial infections including gonorrhea, respiratory tract infections, skin/soft tissue infections, urinary tract infections, bone/joint infections, bacterial septicemia, intra-abdominal infections, meningitis, and pelvic inflammatory disease caused by susceptible organisms. 1

FDA-Approved Indications

IM ceftriaxone is indicated for the following infections when caused by susceptible organisms:

Respiratory Infections

• Lower respiratory tract infections caused by S. pneumoniae, S. aureus, H. influenzae, H. parainfluenzae, K. pneumoniae, E. coli, Enterobacter aerogenes, P. mirabilis, or S. marcescens 1
• Acute bacterial otitis media caused by S. pneumoniae, H. influenzae (including beta-lactamase producing strains), or M. catarrhalis (including beta-lactamase producing strains) 1

Sexually Transmitted Infections

• Uncomplicated gonorrhea (cervical/urethral and rectal) caused by N. gonorrhoeae, including both penicillinase- and non-penicillinase-producing strains 1
• Pharyngeal gonorrhea caused by non-penicillinase-producing strains of N. gonorrhoeae 1
• Pelvic inflammatory disease caused by N. gonorrhoeae (must add antichlamydial coverage as ceftriaxone has no activity against C. trachomatis) 1
• Standard dosing for uncomplicated gonorrhea is 125 mg IM as a single dose 2, 3

Skin and Soft Tissue Infections

• Skin and skin structure infections caused by S. aureus, S. epidermidis, S. pyogenes, Viridans group streptococci, E. coli, Enterobacter cloacae, K. oxytoca, K. pneumoniae, P. mirabilis, M. morganii, P. aeruginosa, S. marcescens, A. calcoaceticus, B. fragilis, or Peptostreptococcus species 1

Urinary Tract Infections

• Complicated and uncomplicated UTIs caused by E. coli, P. mirabilis, P. vulgaris, M. morganii, or K. pneumoniae 1

Serious Systemic Infections

• Bacterial septicemia caused by S. aureus, S. pneumoniae, E. coli, H. influenzae, or K. pneumoniae 1
• Bone and joint infections caused by S. aureus, S. pneumoniae, E. coli, P. mirabilis, K. pneumoniae, or Enterobacter species 1
• Intra-abdominal infections caused by E. coli, K. pneumoniae, B. fragilis, Clostridium species (most strains of C. difficile are resistant), or Peptostreptococcus species 1
• Meningitis caused by H. influenzae, N. meningitidis, or S. pneumoniae 1

Surgical Prophylaxis

• Preoperative prophylaxis: A single 1 g IM dose may reduce postoperative infections in contaminated or potentially contaminated surgical procedures 1

Special Clinical Scenarios

Epididymitis

• For sexually transmitted epididymitis: Ceftriaxone 250 mg IM single dose combined with doxycycline 100 mg orally twice daily for 10 days 2

Disseminated Gonococcal Infection

• Initial treatment: 1 gram IM or IV every 24 hours, continued for 24-48 hours after improvement begins, then switch to oral therapy to complete one week of treatment 3

Pediatric Dosing

• Children weighing ≥45 kg: Use adult dosing regimens 3
• Children <45 kg with uncomplicated gonorrhea: 125 mg IM as a single dose 3
• Children with bacteremia, arthritis, or meningitis (<45 kg): 50 mg/kg (maximum 1 gram) IM/IV daily for 7 days (10-14 days for meningitis) 3

Key Clinical Considerations

Advantages of IM Administration

• Complete absorption following IM administration with peak plasma concentrations occurring 2-3 hours after injection 4
• Long serum half-life (6-8 hours) allows once-daily dosing in most adults and every 12 hours in children 5, 6
• Broad-spectrum activity against both Gram-positive and Gram-negative bacteria 6

Important Limitations

• No oral formulation exists - ceftriaxone is not absorbed adequately from the gastrointestinal tract 4
• Limited activity against Pseudomonas aeruginosa - cannot be recommended as sole therapy for pseudomonal infections 6
• No activity against C. trachomatis - must add appropriate antichlamydial coverage when treating pelvic inflammatory disease 1
• Most strains of C. difficile are resistant 1

Common Pitfalls

• French guidelines recommend IM ceftriaxone for acute otitis media only in exceptional circumstances and must comply with marketing authorization conditions 2
• Resistance can develop during therapy, particularly with Enterobacter and Pseudomonas species 7
• Treatment failures have been reported with lower doses (250-500 mg), particularly for pharyngeal infections with elevated MICs 3