3rd Generation Cephalosporin
Pregnancy: Compatible — widely used for maternal infections in pregnancy
Ceftriaxone
Brand names: Rocephin
Adult dose
Dose: Meningitis: 2–4 g IV OD. Community-acquired pneumonia: 1–2 g IV OD. Septicaemia: 2–4 g IV OD. Gonorrhoea: 1 g IM single dose.
Route: IV or IM
Frequency: Once daily (IV); single dose (gonorrhoea)
Max: 4 g/day
Long half-life allows once daily dosing. Do NOT give with calcium-containing IV fluids in neonates (fatal precipitation). Biliary sludge with prolonged use.
Paediatric dose
Dose: 50 mg/kg
Route: IV or IM
Frequency: Once daily (OD) or BD for meningitis
Max: 4000 mg/day
Concentration: 100 mg/ml
BNF for Children: standard 50–80 mg/kg OD IV/IM (max 4 g/day). Calculator uses 50 mg/kg (standard dose). Meningitis: 80–100 mg/kg/day in 1–2 doses. Neonates: do NOT co-administer with IV calcium (precipitation — potentially fatal). Source: BNF for Children 2024; NICE Bacterial Meningitis Guidelines
Dose adjustments
Renal
No dose adjustment required (biliary excretion predominates)
Hepatic
Reduce dose in combined severe renal AND hepatic impairment (maximum 2 g/day)
Paediatric weight-based calculator
BNF for Children: standard 50–80 mg/kg OD IV/IM (max 4 g/day). Calculator uses 50 mg/kg (standard dose). Meningitis: 80–100 mg/kg/day in 1–2 doses. Neonates: do NOT co-administer with IV calcium (precipitation — potentially fatal). Source: BNF for Children 2024; NICE Bacterial Meningitis Guidelines
Clinical pearls
- Meningococcal disease: 2 g IV STAT if suspected bacterial meningitis (give before LP if delay expected)
- Neonatal caution: co-administration with IV calcium solutions causes precipitation in lung/kidneys — potentially fatal; use different lines and flush between
- Covers most community-acquired organisms; limited against Pseudomonas — use piperacillin-tazobactam or carbapenems for Pseudomonal coverage
- Once daily dosing — concentration-dependent killing; excellent cerebrospinal fluid penetration
Contraindications
- Premature neonates or neonates with hyperbilirubinaemia (displaces bilirubin — kernicterus risk)
- Concurrent IV calcium solutions in neonates
Side effects
- Diarrhoea/C. difficile
- Biliary sludge (especially in children)
- Cephalosporin allergy reactions
- Coombs positivity
- Elevated LFTs
- Thrombocytopenia (rare)
Interactions
- Oral anticoagulants (warfarin) — increased INR
- Oral calcium or calcium-containing IV fluids — precipitation in neonates
Monitoring
- Renal function (with prolonged use)
- LFTs
- FBC (thrombocytopenia)
- Biliary USS (long-term use — biliary sludge)
Reference: BNFc; BNF; NICE Bacterial Meningitis Guidelines; BASHH STI Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways