Third-generation cephalosporin
Ceftriaxone
Beta-lactam that inhibits cell-wall synthesis; broad Gram-negative and useful Gram-positive cover with excellent CSF penetration.
Brands
Rocephin · Monocef
Adult dosing
Maximum 4 g/day| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Community-acquired pneumonia, moderate to severe | 1-2 g | IV or IM | Once daily |
| Bacterial meningitis | 2 gMax 4 g/day | IV | Every 12 hours |
| Gonorrhoea | 1 g | IM | Single dose |
Paediatric dosing
Always confirm the weight and the local paediatric formulary| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Serious infection | 50-80 mg/kg/dayMax 2 g/day | IV | Once daily |
| Meningitis | 100 mg/kg/dayMax 4 g/day | IV | Once daily or divided 12-hourly |
| Neonate | Avoid where possibleBilirubin displacement and calcium precipitation risk | — | — |
Renal adjustment
Move the slider to the patient's eGFRNo adjustment
- eGFR > 10No adjustment
- eGFR ≤ 10Maximum 2 g/day
- DialysisMaximum 2 g/day; no supplementary dose needed
Hepatic adjustment
- Isolated hepatic impairmentNo adjustment
- Combined hepatic and renal impairmentMaximum 2 g/day with level-guided review
Practical notes
The things that go wrong at the bedside- Never co-administer with calcium-containing infusions in the same line, especially in neonates.
- Once-daily dosing supports outpatient parenteral therapy.
DrZep structured dosing table (demo dataset, formulary-aligned) · DrZep. Confirm every dose against your local formulary and the patient's weight, renal function and comorbidities.
Indications
- Moderate to severe community-acquired pneumonia
- Bacterial meningitis (with adjuncts)
- Sepsis of unknown source (empirical, with local guidance)
- Pyelonephritis and complicated urinary infection
- Gonorrhoea, enteric fever, septic arthritis
Dosing summary
- Severe CAP / sepsis
- 1-2 g intravenously once daily
- Meningitis
- 2 g intravenously every 12 hours
- Gonorrhoea
- 500 mg-1 g intramuscularly as a single dose
- Children
- 50-80 mg/kg once daily; 100 mg/kg/day for meningitis (maximum 4 g/day)
Organ adjustment
Renal
- eGFR > 10
- No adjustment (biliary elimination predominates)
- eGFR < 10
- Maximum 2 g/day
Hepatic
- Combined hepatic and renal failure
- Reduce dose and monitor levels where available
Monitoring
- 1Clinical response and de-escalation by 48-72 h with culture results
- 2FBC and liver enzymes in prolonged courses
- 3Line and infusion compatibility
Contraindications & cautions
Do not use / use with care
- Cephalosporin anaphylaxis; caution with severe penicillin anaphylaxis
- Neonates with hyperbilirubinaemia (bilirubin displacement, kernicterus)
- Concurrent calcium-containing intravenous fluids in neonates (precipitation)
Pregnancy & lactation
- Pregnancy
- Considered safe; widely used for serious infection in pregnancy.
- Lactation
- Compatible; minimal transfer into milk.
Interactions
- Calcium-containing IV solutions (Ringer's lactate)Fatal precipitate in neonates; avoid co-administration in any age via the same linemajor
- WarfarinEnhanced anticoagulationmoderate
- AminoglycosidesAdditive nephrotoxicitymoderate
Adverse effects
Common
- Diarrhoea
- Injection-site pain
- Transient transaminase rise
- Eosinophilia
Serious
- C. difficile colitis
- Anaphylaxis
- Biliary pseudolithiasis (sludging)
- Haemolytic anaemia
- Neutropenia with prolonged use
Toxicity & overdose
Recognise and treat
- High cumulative doses risk biliary sludging and encephalopathy in renal failure — reduce dose and hydrate
Alternatives
- Co-amoxiclav plus a macrolide
- Cefotaxime
- Aztreonam or a fluoroquinolone in severe beta-lactam allergy
Linked diseases & guidelines
WHO clinical management of severe acute respiratory infection
Framework for triage, oxygen targets, empirical antimicrobial strategy and escalation in severe respiratory infection.
World Health OrganizationGlobal2023
Surviving Sepsis Campaign international guidelines
Hour-1 bundle, fluid strategy, vasopressor selection and source control principles.
SCCM / ESICMGlobal2021
Demo monograph for educational use. Always confirm dose, route and interactions against your national formulary and the product label before prescribing.
Demo content. Educational decision support only. Verify every dose, citation and recommendation against your national formulary and the primary source before clinical use.