Intramuscular Ceftriaxone Injection Site for Gonorrhea
For gonorrhea treatment, inject ceftriaxone intramuscularly into either the deltoid or the buttocks (gluteal muscle)—both sites are equally acceptable and effective, with the choice based primarily on patient comfort, volume of injection, and clinical convenience. 1
Guideline Recommendations on Injection Site
The CDC treatment guidelines specify ceftriaxone 250 mg IM as the recommended regimen for uncomplicated gonorrhea but do not mandate a specific injection site. 1, 2 Both the deltoid and gluteal muscles are standard intramuscular injection sites used in clinical practice for ceftriaxone administration. 3, 4
Practical Considerations for Site Selection
Deltoid Muscle (Upper Arm)
- Preferred for smaller volumes (≤2 mL), making it ideal for the standard 250 mg dose of ceftriaxone 4
- More convenient for patient positioning and requires less undressing
- Faster absorption due to better blood flow compared to gluteal site
- Maximum volume: 1-2 mL in adults
Gluteal Muscle (Buttocks)
- Preferred for larger volumes or when multiple injections are needed
- Ventrogluteal site is safest to avoid sciatic nerve injury if using the buttocks 4
- Can accommodate up to 5 mL in adults
- May be preferred in patients with limited deltoid muscle mass
Clinical Evidence on Efficacy
The extensive clinical trials demonstrating ceftriaxone's 98.9% cure rate for uncomplicated gonorrhea used intramuscular administration without specifying injection site restrictions, indicating that efficacy is independent of whether deltoid or gluteal sites are used. 1, 3 Single-dose ceftriaxone 125-250 mg IM achieves sustained, high bactericidal blood levels regardless of injection site. 1, 4
Current Treatment Recommendations
The CDC recommends ceftriaxone 250 mg IM in a single dose PLUS azithromycin 1 g orally for all uncomplicated gonococcal infections of the cervix, urethra, rectum, and pharynx. 1, 2, 5 This dual therapy addresses both gonorrhea and potential chlamydial co-infection while combating antimicrobial resistance. 1, 2
Common Pitfalls to Avoid
- Never use the dorsogluteal site (upper outer buttock quadrant) due to risk of sciatic nerve injury—if using the buttocks, use the ventrogluteal site instead
- Ensure proper needle length (typically 1-1.5 inches for deltoid, 1.5-2 inches for gluteal in average-weight adults) to reach muscle tissue
- Do not substitute oral cefixime unless ceftriaxone is truly unavailable, as it has lower efficacy and requires mandatory test-of-cure 1, 2
- Always add azithromycin 1 g orally to the ceftriaxone—never use ceftriaxone monotherapy 1, 2, 5