Ceftriaxone

How it works

It inhibits bacterial cell-wall synthesis by binding penicillin-binding proteins, and its long half-life supports once-daily administration.

Prescribing in practice

• Avoid in patients with a history of severe hypersensitivity to cephalosporins or penicillins, as serious cross-reactive reactions including anaphylaxis can occur.
• Do not co-administer with calcium-containing intravenous solutions in neonates because of the risk of fatal calcium-ceftriaxone precipitates; caution applies to the perinatal period.
• It can be used in pregnancy when a cephalosporin is indicated, and is first-line in current guidance for gonorrhoea given rising resistance.

Monitoring

Routine monitoring is not usually needed, but assess clinical response and consider liver and renal function and biliary symptoms with prolonged use.

Counselling the patient

• This antibiotic is given by injection or infusion, usually once daily.
• Report any rash, swelling, jaundice or breathing difficulty promptly.
• Attend for any recommended test of cure or partner notification when treating sexually transmitted infection.

Evidence & guidelines

Ceftriaxone is recommended by current UK and international guidance as first-line therapy for gonorrhoea and a key component of pelvic inflammatory disease regimens.