From the Guidelines
Ceftriaxone is an effective option for treating E. coli urinary tract infections (UTIs), particularly in cases where oral antibiotics are not appropriate or in complicated UTIs. Ceftriaxone is a third-generation cephalosporin antibiotic that has excellent activity against most E. coli strains, including many that cause UTIs. The typical dose for treating UTIs is 1-2 grams intravenously or intramuscularly once daily, with treatment duration typically ranging from 7-14 days depending on infection severity, as suggested by guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women 1. Some key points to consider when using ceftriaxone for E. coli UTIs include:
- Local antibiotic resistance patterns should be considered, especially with increasing rates of extended-spectrum beta-lactamase (ESBL) producing E. coli, which may limit its effectiveness in some cases.
- Ceftriaxone requires parenteral administration, making it typically used in hospitalized patients or outpatient parenteral antibiotic therapy settings rather than for uncomplicated UTIs, which are usually treated with oral antibiotics.
- The choice of ceftriaxone should be based on local resistance data and tailored on the basis of susceptibility results, as recommended for the treatment of pyelonephritis requiring hospitalization 1. It's also important to note that while ceftriaxone can be effective, the prevalence of fluoroquinolone resistance among outpatient uncomplicated pyelonephritis isolates should be considered, and in areas with high resistance rates, alternative treatments may be preferred 1.
From the FDA Drug Label
Ceftriaxone for injection USP is indicated for the treatment of the following infections when caused by susceptible organisms: ... Urinary Tract Infections (complicated and uncomplicated) caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae Ceftriaxone covers E. coli UTI, as it is indicated for the treatment of urinary tract infections caused by Escherichia coli 2.
- The drug label explicitly lists E. coli as one of the susceptible organisms for urinary tract infections.
- Key points:
- Ceftriaxone is effective against E. coli in urinary tract infections.
- The indication includes both complicated and uncomplicated urinary tract infections.
From the Research
Ceftriaxone Coverage for E. coli UTI
- Ceftriaxone is a third-generation cephalosporin that has been shown to be effective against E. coli in urinary tract infections (UTIs) 3, 4.
- A study published in 2018 found that ceftriaxone had a high susceptibility rate against E. coli isolates from adult patients with community-acquired UTIs, with 80% of isolates being susceptible to the antibiotic 3.
- Another study published in 2024 found that ceftriaxone had a high susceptibility rate against E. coli, Klebsiella pneumoniae, and Proteus mirabilis urinary isolates, with 97% of isolates being susceptible to the antibiotic 4.
- However, ceftriaxone has also been associated with an increased risk of hospital-onset Clostridioides difficile infection (HOCDI) compared to other antibiotics, such as cefazolin 4, 5.
- A study published in 2025 found that cefazolin was a safe and effective alternative to ceftriaxone for the empiric treatment of patients with complicated UTIs, with similar clinical success rates and no significant differences in length of stay or development of CDI 6.
Susceptibility of E. coli to Ceftriaxone
- The susceptibility of E. coli to ceftriaxone can vary depending on the population being studied and the specific antibiotic resistance patterns in the area 3, 4.
- A study published in 2018 found that the susceptibility of E. coli to ceftriaxone was higher in adult patients than in children, with 80% of adult isolates being susceptible to the antibiotic compared to 65.9% of pediatric isolates 3.
- Another study published in 2024 found that the susceptibility of E. coli to ceftriaxone was higher in uncomplicated UTIs than in complicated UTIs, with 97% of uncomplicated isolates being susceptible to the antibiotic compared to 92.5% of complicated isolates 4.
Clinical Implications
- Ceftriaxone can be an effective treatment option for E. coli UTIs, particularly in adult patients with community-acquired infections 3, 4.
- However, the use of ceftriaxone should be carefully considered in patients with complicated UTIs or those at high risk for HOCDI, as alternative antibiotics such as cefazolin may be safer and equally effective 4, 5, 6.