Classifications: antibiotic; third-generation cephalosporin;
; cephalosporin
Prototype: Cefotaxime sodium
Pregnancy Category: B


250 mg, 500 mg, 1 g, 2 g injection


Semisynthetic third-generation cephalosporin antibiotic. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium.

Therapeutic Effect

Similar to other third-generation cephalosporins, ceftriaxone is effective against serious gram-negative organisms and also penetrates the CSF in concentrations useful in treatment of meningitis.


Infections caused by susceptible organisms in lower respiratory tract, skin and skin structures, urinary tract, bones and joints; also intra-abdominal infections, pelvic inflammatory disease, uncomplicated gonorrhea, meningitis, and surgical prophylaxis.


Hypersensitivity to cephalosporins and related antibiotics; viral infections; neonates with hyperbilirubinemia, premature neonates.

Cautious Use

Coagulopathy, GI disease, colitis; renal disease, renal impairment; pregnancy (category B).

Route & Dosage

Moderate to Severe Infections
Adult: IV/IM 1–2 g q12–24h (max: 4 g/d)
Child: IV/IM 50–75 mg/kg/d in 2 divided doses (max: 2 g/d)

Adult: IV/IM 2 g q12h
Child: IV/IM 100 mg/kg/d in 2 divided doses (max: 4 g/d)

Surgical Prophylaxis
Adult: IV/IM 1 g 30–120 min before surgery

Uncomplicated Gonorrhea
Adult: IM 250 mg as single dose
Child: IM 125 mg as single dose


  • Reconstitute the 1 g or 2 g vial by adding 2.1 mL or 4.2 mL, respectively, of sterile water for injection. Yields 350 mg/mL. See manufacturer's directions for other dilutions.
  • Give deep IM into a large muscle.
  • IV administration to infants and children: Verify correct IV concentration and rate of infusion with physician.

PREPARE: Intermittent: Reconstitute each 250 mg with 2.4 mL of sterile water, D5W, NS, or D5/NS to yield 100 mg/mL. Further dilute with 50–100 mL of the selected IV solution.  

ADMINISTER: Intermittent: Give over 30 min.  

INCOMPATIBILITIES Solution/additive: aminoglycosides, aminophylline, clindamycin, lidocaine, linezolid, metronidazole, theophylline, calcium containing products. Y-site: aminoglycosides, amphotericin B cholesteryl complex, amsacrine, azithromycin, calcium containing products, filgrastim, fluconazole, labetalol, pentamidine, vancomycin, vinorelbine.

  • Protect sterile powder from light. Store at 15°–25° C (59°–77° F). Reconstituted solutions: diluent, concentration of solutions are determinants of stability. See manufacturer's instructions for storage.

Adverse Effects (≥1%)

Body as a Whole: Pruritus, fever, chills, pain, induration at IM injection site; phlebitis (IV site). GI: Diarrhea, abdominal cramps, pseudomembranous colitis, biliary sludge. Urogenital: Genital pruritus; moniliasis.

Diagnostic Test Interference

Causes prolonged PT/INR during therapy.


Drug: Probenecid decreases renal elimination of ceftriaxone; alcohol produces disulfiram reaction; effect of warfarin may be increased.


Peak: 1.5–4 h after IM; immediately after IV. Distribution: Widely distributed in body tissues and fluids; good CNS penetration; crosses placenta. Metabolism: Not metabolized. Elimination: 33–65% unchanged in urine; also in bile and breast milk. Half-Life: 5–10 h.

Nursing Implications

Assessment & Drug Effects

  • Determine history of hypersensitivity reactions to cephalosporins and penicillins and history of other allergies, particularly to drugs, before therapy is initiated.
  • Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy. Dosage may be started pending test results. Periodic coagulation studies (PT and INR) should be done.
  • Inspect injection sites for induration and inflammation. Rotate sites. Note IV injection sites for signs of phlebitis (redness, swelling, pain).
  • Monitor for manifestations of hypersensitivity (see Appendix F). Report their appearance promptly and discontinue drug.
  • Watch for and report signs: petechiae, ecchymotic areas, epistaxis, or any unexplained bleeding. Ceftriaxone appears to alter vitamin K–producing gut bacteria; therefore, hypoprothrombinemic bleeding may occur.
  • Check for fever if diarrhea occurs: Report both promptly. The incidence of antibiotic-produced pseudomembranous colitis (see Appendix F) is higher than with most cephalosporins. Most vulnerable patients: chronically ill or debilitated older adult patients undergoing abdominal surgery.

Patient & Family Education

  • Report any signs of bleeding.
  • Report loose stools or diarrhea promptly.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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