Ceftriaxone
A once-daily third-generation cephalosporin for sepsis, meningitis, pneumonia, pyelonephritis and gonorrhoea. Not reliable for XDR typhoid.
Common brands in Pakistan: Rocephin. Brand availability changes; check with your pharmacy.
On this page
Uses
- Sepsis, community-acquired pneumonia (with clarithromycin), pyelonephritis.
- Bacterial meningitis, meningococcal disease.
- Spontaneous bacterial peritonitis, cholangitis (with metronidazole), appendicitis (with metronidazole).
- Gonorrhoea.
- Typhoid only when culture shows sensitivity (XDR strains are resistant).
Adult dose
| Indication | Dose |
|---|---|
| Most serious infections | 1–2 g IV or IM once daily |
| Meningitis | 2 g IV every 12 hours |
| Gonorrhoea | 1 g IM single dose (per current guidance) |
Children's dose
| Indication | Dose |
|---|---|
| Sepsis, pneumonia | 50–80 mg/kg IV once daily (max 4 g) |
| Meningitis | 100 mg/kg IV once daily or 50 mg/kg every 12 hours (max 4 g/day) |
| Neonates | Avoid in jaundiced or premature neonates and with IV calcium; use cefotaxime |
Kidney and liver
Usually no adjustment unless both kidney and liver impairment are severe (max 2 g/day).
Pregnancy and breastfeeding
Considered safe.
Side effects and cautions
- Allergy (cross-reactivity with penicillin is low but avoid after severe penicillin anaphylaxis).
- Biliary sludge with high doses.
- C. difficile diarrhoea.
- Must not be given in the same line as calcium-containing fluids (including Ringer's lactate) in neonates.
Frequently asked questions
What is the ceftriaxone dose for meningitis in adults?
2 g IV every 12 hours.
Can ceftriaxone treat typhoid in Pakistan?
Only if the culture shows the organism is sensitive. XDR typhoid is resistant; azithromycin or meropenem is used instead.
Used in these guides
- Acute diverticulitis
- Appendicitis
- Ascitic tap and paracentesis
- Community-acquired pneumonia
- Decompensated cirrhosis on the ward
- Epididymo-orchitis
- Gallstone disease: colic, cholecystitis, cholangitis
- Headache in the emergency department
- Hernias in the emergency department
- Lumbar puncture
- Meningitis and encephalitis
- Perforated viscus and peritonitis
- Pyelonephritis
- Rashes in children
- Red eye and conjunctivitis
- Reduced consciousness (the unconscious patient)
- Renal colic (kidney stones)
- Sepsis
- Sepsis in children
- Septic arthritis
- The febrile child
- The limping child
- Upper GI bleed
- Vaginal bleeding in pregnancy
Sources
Doses on this page are typical doses from the sources above. Always confirm with a current drug reference, the product leaflet and your hospital protocol, especially in children, pregnancy and kidney or liver disease.
For FCPS Part 1
Revising for FCPS Part 1? Ceftriaxone is covered in our textbook chapter Antibacterial drugs, with practice MCQs.