4/4/2018 Ceftriaxone | Guidelines for Antibiotic Use

Ceftriaxone

Restriction Status
JHH: Unrestricted
Bayview: Unrestricted

Important Notes
Patients with non-severe PCN allergies (e.g., rash) can receive Ceftriaxone as minimal (< 2%) cross-reactivity
has been demonstrated.
Patients with severe PCN allergy (e.g., anaphylaxis) should not receive any cephalosporins without consulting
with Allergy and Immunology.

Activity
Ceftriaxone is a third generation cephalosporin with a broad spectrum of activity against many Gram-positive and
Gram-negative organisms.
It does NOT have activity against MRSA or Pseudomonas spp..
Similar to all cephalosporins, ceftriaxone does NOT have activity against enterococci.
Ceftriaxone has activity against Neisseria spp., Vibrio spp., HACEK organisms, and Borrelia spp.
It has activity against Gram-positive anaerobes such as P. acnes and Peptostreptococcus spp. but does not have
activity against Gram-negative anaerobes such as B. fragilis.

Acceptable Use
Empiric treatment for community-acquired pneumonia (CAP), mild to moderate healthcare-acquired pneumonia
(HAP), pyelonephritis, community-acquired meningitis (in combination with Vancomycin), mild to moderate intra-
abdominal infections (in combination with Metronidazole), orbital cellulitis
CNS infections caused by E. coli, Klebsiella spp. and Streptococcus spp.
Empiric treatment of osteomyelitis and septic arthritis when coverage for Pseudomonas spp. is not needed
E. faecalis endocarditis in combination with Ampicillin. Note: despite in vitro resistance, Ceftriaxone plus
Ampicillin has synergy against E. faecalis
Endocarditis caused by Streptococcus spp., HACEK organisms or culture-negative endocarditis
Gonococcal infections
Lyme meningitis or carditis
Spontaneous bacterial peritonitis (SBP) treatment and prophylaxis
Infections caused by non-cholera Vibrio spp.

Unacceptable Use
Serious infections caused by MSSA (e.g., bacteremia and pneumonia)
Infections caused by Enterobacter spp. (due to high failure rates in Amp-C producing isolates)
Neurosyphillis

Adult Dosing

Standard Dosing
Usual dose: 1 g IV Q24H
Orbital cellulitis, osteomyelitis, septic joint infections, Lyme meningitis or carditis, culture-negative endocarditis,
endocarditis caused by Streptococcus spp. and HACEK organisms, H. influenzae pneumonia: 2 g IV Q24H
E. faecalis endocarditis: 2 g IV Q12H
SBP treatment: 1 g IV Q12H
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4/4/2018 Ceftriaxone | Guidelines for Antibiotic Use

SBP prophylaxis: 1 g IV Q24H

CNS infections: 2 g IV Q12H
GU gonococcal infections: 250 mg IM once

Renal Dosing
Limit daily dose to 2 g IV Q24H in patients with ESRD and liver cirrhosis

Hepatic Dosing
Limit daily dose to 2 g IV Q24H in patients with ESRD and liver cirrhosis

Monitoring

Safety
Weekly: CBC, BUN, SCr

Lab Interactions
Hypersensitivity reactions (rash)
Biliary sludging and pseudocholelithiasis
Pancytopenia with prolonged use and higher doses (e.g., 2 g IV Q12H)
C. difficile infection

Adverse Effects
Biliary sludging and pseudocholelithiasis, pancytopenia with prolonged use and higher doses (e.g., 2 g IV Q12H),
hypersensitivity, C. difficile infection

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