Third-Generation Cephalosporin — Meningitis / Sepsis / Community-Acquired Pneumonia Pregnancy: Safe — widely used in pregnancy for serious infections

Ceftriaxone (Paediatric)

Brand names: Rocephin

Adult dose

Dose: 1–2 g IV/IM once daily; meningitis: 2 g IV every 12 hours

Route: IV or IM

Frequency: Once daily (most indications); every 12 hours (meningitis)

Max: 4 g/day

Adult reference — see paediatric dose section

Paediatric dose

Dose: 50–100 mg/kg once daily; Meningitis: 100 mg/kg/day in 1–2 divided doses mg/kg

Route: IV infusion (over 30–60 minutes) or deep IM (lidocaine diluent for IM)

Frequency: Once daily (most); every 12 hours (meningitis)

Max: 4 g/day (meningitis); 2 g/day (other infections)

BNFc: CRITICAL — avoid in neonates <41 weeks corrected gestational age if jaundiced or receiving calcium-containing IV fluids (risk of ceftriaxone-calcium precipitates in lungs/kidneys — potentially fatal); for neonates use cefotaxime instead. For meningitis in children ≥3 months — give ceftriaxone IV within 1 hour of clinical recognition (NICE NG41). IM route: dilute in 1% lidocaine to reduce injection pain.

Dose adjustments

Renal

No dose adjustment for mild-moderate impairment; use cefotaxime instead in significant renal impairment (dual elimination via bile and kidney)

Hepatic

Use with caution in combined severe hepatic + renal impairment; reduce dose

Paediatric weight-based calculator

Patient weight (kg)

Clinical pearls

Neonatal contraindication: ceftriaxone + calcium (including TPN) forms insoluble precipitates in blood vessels — fatal pulmonary/renal/hepatic precipitation reported; cefotaxime is the safe alternative for neonates
Biliary sludge: ceftriaxone excreted in bile and can form calcium-ceftriaxone precipitates in gallbladder — usually asymptomatic and reversible on stopping; monitor with USS if abdominal pain
Once-daily dosing: major advantage over cefotaxime (every 6 hours) — suitable for outpatient parenteral therapy and reducing nursing burden in meningitis
Empirical meningitis coverage: ceftriaxone covers N. meningitidis, S. pneumoniae, H. influenzae — add ampicillin for Listeria coverage if age <3 months or immunocompromised

Contraindications

Neonates with jaundice, hypoalbuminaemia, or receiving IV calcium (fatal precipitates)
Premature neonates <41 weeks corrected gestational age
Cephalosporin hypersensitivity

Side effects

GI disturbance
Biliary sludge / pseudolithiasis (cholestasis — more common in children, usually reversible)
Ceftriaxone-calcium precipitation (in neonates)
Rash
Elevated LFTs
C. difficile
Positive Coombs test

Interactions

IV calcium-containing solutions — absolute contraindication to simultaneous infusion in all age groups; neonates — avoid even sequentially
Warfarin — enhanced anticoagulant effect

Monitoring

Renal function and LFTs
FBC
C. difficile if diarrhoea
Biliary USS if abdominal symptoms develop
Clinical response and CRP

Reference: BNF for Children; NICE NG41 (Meningitis in Children); PHE Meningococcal Disease Guidelines; RCPCH Antibiotic Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways