Third-generation cephalosporin
Ceftriaxone is a broad-spectrum injectable antibiotic of the cephalosporin family (third generation), used in severe infections, including meningitis, sepsis, pneumonia and gonorrhoea. Because of its long half-life, it can be given once daily.
Also known as: Ceftriaxona, Rocephin
Ceftriaxone may prolong prothrombin time and potentiate the anticoagulant effect of Warfarin, especially during prolonged therapy.
Ceftriaxone is a broad-spectrum cephalosporin that reduces the gut flora producing vitamin K. Since warfarin is a vitamin K antagonist, the lower endogenous availability of the cofactor raises the INR and the bleeding risk. The effect is more relevant in malnourished, elderly, liver-disease or prolonged-antibiotic patients. Monitor the INR during and after treatment and adjust the warfarin dose; watch for bleeding signs.
Cephalosporins can potentiate warfarin by reducing the gut flora that produces vitamin K. Monitor the INR during and after the antibiotic.
Risk of vitamin K deficiency and altered clotting-factor synthesis with prolonged use; additive effect with the anticoagulant.
Prothrombin time/INR, signs of bleeding.
Unexplained bleeding, extensive bruising, melena.
Monitor PT/INR; consider vitamin K supplementation with prolonged use or in the elderly.
DailyMed/FDA (NIH/NLM) — approved Ceftriaxone label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9efed4c4-72a7-4669-88ae-c80e882c1b37 ; approved Warfarin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=541c9a70-adaf-4ef3-94ba-ad4e70dfa057
No direct interaction is known between ceftriaxone and alcohol; caution is advised during treatment.
Limit alcohol intake during treatment.
DailyMed/FDA (NIH/NLM) — approved Ceftriaxone label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9efed4c4-72a7-4669-88ae-c80e882c1b37
Ceftriaxone is given intravenously or intramuscularly; it has no significant food interaction.
No need to adjust dosing around meals.
DailyMed/FDA (NIH/NLM) — approved Ceftriaxone label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9efed4c4-72a7-4669-88ae-c80e882c1b37
Ceftriaxone displaces bilirubin from albumin and is contraindicated in neonates with hyperbilirubinaemia (risk of bilirubin encephalopathy).
Contraindicated in neonates with hyperbilirubinaemia; prefer an alternative.
DailyMed/FDA (NIH/NLM) — approved Ceftriaxone label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9efed4c4-72a7-4669-88ae-c80e882c1b37
Ceftriaxone is a cephalosporin; it is contraindicated in prior cephalosporin allergy and requires caution in severe penicillin allergy (cross-reactivity).
Contraindicated in cephalosporin allergy; caution in severe penicillin allergy.
DailyMed/FDA (NIH/NLM) — approved Ceftriaxone label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9efed4c4-72a7-4669-88ae-c80e882c1b37
Cephalosporins, including ceftriaxone, are generally safe in pregnancy when indicated.
May be used in pregnancy when indicated; avoid in neonates with hyperbilirubinaemia (not applicable in pregnancy).
Excreted into breast milk in small amounts; compatible with breastfeeding.
No specific additional contraception.
DailyMed/FDA (NIH/NLM) — approved Ceftriaxone label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9efed4c4-72a7-4669-88ae-c80e882c1b37
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Broad-spectrum third-generation cephalosporin with a long half-life (once-daily dosing), CSF penetration and dual elimination (renal + biliary); attention to calcium precipitation in neonates.
Inhibits bacterial cell wall synthesis by binding to PBPs (peptidoglycan transpeptidation); time-dependent bactericidal with activity against Gram-positives and Gram-negatives, including meningococci, gonococci and Treponema.
IV/IM administration (no oral absorption); reversible, concentration-dependent protein binding (95% at <25 mcg/mL → 85% at 300 mcg/mL); volume of distribution 5.78-13.5 L; crosses the placenta and penetrates well into CSF with inflamed meninges.
Not significantly metabolised; dual elimination: ~33-67% unchanged renally and the rest biliarily (no adjustment for isolated renal impairment, except when combined with severe hepatic impairment).
Elimination half-life 5.8-8.7 h in adults (0.15-3 g); 4.3-4.6 h in children with meningitis; plasma clearance 0.58-1.45 L/h; renal 0.32-0.73 L/h.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
