Third-generation cephalosporins
Brand names: Ceftriaxona Normon, Rocephin, Ceftriaxona Kabi
Updated · Methodology
First line
Moderate-to-severe community-acquired pneumonia. /ATS 2019 and Spanish SEPAR 2024 position ceftriaxone 1–2 g once daily as the empiric backbone in hospitalized patients combined with a macrolide (azithromycin 500 mg or clarithromycin) or a respiratory fluoroquinolone (levofloxacin). Treatment duration 5–7 days with typical response. ICU patients receive 2 g/day.
Sources
ICD-10: J18.9 · ICD-11: CA40.Z
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Ceftriaxone is used in outpatient settings for upper respiratory infections and mild COVID-19 as a fallback. 2024 AWaRe places ceftriaxone in the Watch category, recommending limited inpatient use. NG191 2020 and 2019 do not include ceftriaxone in outpatient URI standards. Intramuscular pediatric use without bacterial confirmation drives irrational use and resistance.
Sources
ICD-10: J00 · ICD-11: CA00
Parenteral third-generation cephalosporin. Inhibits bacterial cell wall synthesis via penicillin-binding protein (PBP) binding. Spectrum includes Gram-negative (E. coli, K. pneumoniae, P. mirabilis, H. influenzae, M. catarrhalis, Neisseria gonorrhoeae, Neisseria meningitidis) and some Gram-positive (S. pneumoniae, S. pyogenes). Not active against Pseudomonas aeruginosa, MRSA, Enterococcus, or most anaerobes. Half-life 6–9 hours – among the longest in the class, allowing once-daily dosing.
AEMPS summary of product characteristics (section 4.6): ceftriaxone crosses the placenta, and data on its use in pregnant women are limited. Animal studies found no direct or indirect harmful effects on embryo-fetal, perinatal or postnatal development. During pregnancy, especially in the first trimester, ceftriaxone is given only if the expected benefits outweigh the risks.
Milk levels are low; infant risk minimal. Infant diarrhea or candidiasis possible.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Verbatim lines from the interaction sections, in the language of the label
«No hay una evidencia clara en cuanto a un potencial aumento de la toxicidad renal de los aminoglucósidos cuando se utilizan con cefalosporinas. En tales casos se debe mantener una estrecha vigilancia…»AEMPS, section 4.5 · Open on CIMA
«El uso concomitante con anticoagulantes orales puede aumentar el efecto anti-vitamina K y el riesgo de hemorragia. Se recomienda monitorizar con frecuencia la International Normalised Ratio (INR) y…»AEMPS, section 4.5 · Open on CIMA
«En un estudio in vitro , se han observado efectos antagonistas tras la combinación de cloranfenicol y ceftriaxona. Se desconoce la repercusión clínica.»AEMPS, section 4.5 · Open on CIMA
«No se ha observado insuficiencia en la función renal tras la administración concomitante de dosis altas de ceftriaxona y diuréticos potentes (por ejemplo, furosemida).»AEMPS, section 4.5 · Open on CIMA
«No se ha observado insuficiencia en la función renal tras la administración concomitante de dosis altas de ceftriaxona y diuréticos potentes (por ejemplo, furosemida).»AEMPS, section 4.5 · Open on CIMA
«Antibacterianos : Ceftriaxona: Hay estudios en los que se ha registrado un incremento de su eliminación por el diclofenaco.»AEMPS, section 4.5 · Open on CIMA
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Ceftriaxone is evaluated for the following indications with varying evidence strength: Community-acquired pneumonia (evidence tier A), Common cold (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ceftriaxone (≥ 1 in 100): IM injection-site pain (without lidocaine), Diarrhea, Nausea, Rash, Eosinophilia, Thrombocytosis. See the Safety section for uncommon and serious reactions.
AEMPS summary of product characteristics (section 4.6): ceftriaxone crosses the placenta, and data on its use in pregnant women are limited. Animal studies found no direct or indirect harmful effects on embryo-fetal, perinatal or postnatal development. During pregnancy, especially in the first trimester, ceftriaxone is given only if the expected benefits outweigh the risks.
Milk levels are low; infant risk minimal. Infant diarrhea or candidiasis possible.
Ceftriaxone is contraindicated in: Cephalosporin hypersensitivity; Anaphylaxis to penicillins (cross-allergy 1–10%); Neonatal hyperbilirubinemia – kernicterus risk; Calcium-containing solutions in neonates. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Cefuroxime axetil, Chloramphenicol, Ciprofloxacin, Clarithromycin, Clindamycin, Flucloxacillin, Meropenem, Amoxicillin + Clavulanic Acid