Antibiotic — Cephalosporin Pregnancy: Ceftriaxone crosses the placental barrier; limited data in pregnant women. Should only be administered during pregnancy, in particular the first trimester, if the benefit outweighs the risk. Excreted into human milk in low concentrations; at therapeutic doses no effects on breastfed infants anticipated, though a risk of diarrhoea and fungal infection of the mucous membranes cannot be excluded. Decide whether to discontinue breast-feeding or ceftriaxone therapy weighing benefits to child and mother.

Ceftriaxone

Brand names: Rocephin

Ceftriaxone is a parenteral third-generation cephalosporin with broad Gram-negative activity, used in obstetrics and gynaecology for pelvic inflammatory disease, gonococcal infection and serious systemic infection including in pregnancy.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1-2 g

Route: Intravenous or intramuscular

Frequency: Once daily

Max: 4 g daily

Adults and children over 12 years (>=50 kg). Dose depends on severity, susceptibility, site and type of infection. SPC table: 1-2 g once daily for community acquired pneumonia, acute exacerbations of COPD, intra-abdominal infections and complicated UTI/pyelonephritis; 2 g once daily for hospital acquired pneumonia, complicated skin and soft tissue infections and bone/joint infections; 2-4 g once daily for febrile neutropenia (suspected bacterial), bacterial endocarditis and bacterial meningitis. In documented bacteraemia use the higher end of the range; twice daily (12 hourly) may be considered where doses greater than 2 g daily are given. Indications of particular obstetric/gynaecological relevance: gonorrhoea 500 mg as a single IM dose; syphilis 500 mg-1 g once daily increased to 2 g once daily for neurosyphilis for 10-14 days (limited data; follow national/local guidance); pre-operative prophylaxis of surgical site infections 2 g as a single pre-operative dose. Pregnancy: ceftriaxone crosses the placental barrier and should only be used in pregnancy, in particular the first trimester, if benefit outweighs risk. Duration: continue for 48-72 hours after the patient is afebrile or bacterial eradication achieved. Paediatric/neonatal weight-based schedules are given in the SPC — contraindicated in premature neonates up to postmenstrual age 41 weeks and in certain full-term neonates; verify all paediatric dosing against a children's formulary.

Dose adjustments

Renal

No dose reduction needed in impaired renal function provided hepatic function is not impaired. Only in preterminal renal failure (creatinine clearance <10 mL/min) should the dosage not exceed 2 g daily.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to ceftriaxone, to any other cephalosporin, or to any of the excipients
History of severe hypersensitivity (e.g. anaphylactic reaction) to any other type of beta-lactam antibacterial agent (penicillins, monobactams and carbapenems)
Premature neonates up to a postmenstrual age of 41 weeks (gestational age + chronological age)
Full-term neonates (up to 28 days) with hyperbilirubinaemia, jaundice, or who are hypoalbuminaemic or acidotic
Full-term neonates (up to 28 days) if they require or are expected to require intravenous calcium treatment or calcium-containing infusions
Ceftriaxone solutions containing lidocaine must never be administered intravenously

Side effects

Eosinophilia, leucopenia, thrombocytopenia
Diarrhoea, loose stools, nausea, vomiting
Rash, pruritus, urticaria
Hepatic enzyme increased
Phlebitis, injection site pain, pyrexia

Clinical monograph

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.

Reference: BASHH Gonorrhoea Guidelines (2019); BASHH PID Guidelines (2019); RCOG GBS Guidelines (2017); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators