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Third-generation cephalosporin Pregnancy: Generally considered safe in second/third trimester.

Ceftriaxone

Brand names: Rocephin

Adult dose

Dose: 1–2 g IV/IM once daily; meningitis: 2 g IV twice daily
Route: IV (over 30 min) or IM
Frequency: Once daily (most infections); twice daily (meningitis/endocarditis)
Max: 4 g/day
Bacterial meningitis: 2 g IV BD. Community-acquired pneumonia (severe): 1–2 g OD. Sepsis: 2 g OD. Gonorrhoea: 500 mg IM single dose. NEVER mix in same line as calcium-containing solutions (precipitate).

Paediatric dose

Dose: 50 mg/kg
Route: IV or IM
Frequency: Once daily (or twice daily for meningitis)
Max: 4 g/day (meningitis); 2 g/day (other indications)
Concentration: 100 mg/ml
Neonates ≥41 weeks: 50 mg/kg OD (avoid in neonates if jaundiced or receiving calcium IV — fatal precipitate). >28 days: 50 mg/kg OD (max 2 g); meningitis: 50–100 mg/kg BD (max 4 g/day).

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required.

Paediatric weight-based calculator

Neonates ≥41 weeks: 50 mg/kg OD (avoid in neonates if jaundiced or receiving calcium IV — fatal precipitate). >28 days: 50 mg/kg OD (max 2 g); meningitis: 50–100 mg/kg BD (max 4 g/day).

Clinical pearls

  • Gold standard for bacterial meningitis empirical treatment
  • First-line for gonorrhoea (250 mg IM — 500 mg IM if >150 kg)
  • Biliary pseudolithiasis with prolonged use — usually asymptomatic
  • Caution in penicillin allergy: 1–2% cross-reactivity
  • Once-daily dosing ideal for community IV therapy (OPAT)

Contraindications

  • Cephalosporin hypersensitivity
  • Neonates with jaundice or receiving IV calcium (life-threatening precipitate in lungs/kidneys)
  • Premature neonates

Side effects

  • Diarrhoea and GI upset
  • C. difficile colitis
  • Hypersensitivity reactions
  • Biliary sludge (ceftriaxone forms calcium-ceftriaxone bile precipitates)
  • Thrombophlebitis at IV site

Interactions

  • Calcium-containing solutions — FATAL precipitation in neonates; avoid mixing in same line at any age

Monitoring

  • Response to treatment
  • LFTs (prolonged use)
  • Renal function (high doses)

Reference: BNFc; BNF; NICE NG240 Bacterial Meningitis; PHE guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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