Ceftriaxone (in the form of sodium ceftriaxone)
Ceftriaxone is used in the treatment of lower respiratory tract infections,
skin and its structures infections, bone and joint infections,
intra-abdominal infections, urinary tract infections, meningitis, septicaemia and provoked gonorrhoea. Ceftriaxone is also used for peri-surgery
Due to the fact that, ceftriaxone has a prolongated half-life and can be
used once daily, some clinicians suggest this drug can be useful in the
treatment of infections caused by susceptible microorganisms, that require
prolongated therapy in ambulatory patients (osteomyelitis). Ceftriaxone has
been used successfully in the treatment of adults and children in
ambulatory, in some cases the drug was self-administrated. Before initiating
the therapy with ceftriaxone, the adequate samples should be collected to
identify the causative microorganism and study in vitro sensitivity. Therapy
with ceftriaxone can be initiated while waiting for the sensitivity tests
results, but should be interrupted if the microorganism demonstrates
resistance to this antibiotic.
Bacterial Infections caused by Gram-positive Aerobics
In general ceftriaxone has been effective in adults and children in the
treatment of skin cutaneous structures infections, pneumonia, urinary tract
infections, bone and joint infections or septicaemia caused by sensitive
Gram-positive coccus (Staphylococcus aureus, Streptococci from
groups A and B, Streptococcus pneumoniae). However, many clinicians
share the opinion that ceftriaxone, like other 3rd generation cephalosporins
, should not be used in the treatment of infections caused by Gram-positive
bacteria when penicillin or 1st generation cephalosporins can be used.
Bacterial Infections caused by Gram-negative Aerobics
Ceftriaxone is used in the treatment of lower respiratory tract infections
caused by: Haemophilus influenza, Haemophilus parainfluenza,
Enterobacter xerogenes, Escherichia coli, Klebsiella
(including K. Pneumoniae), Proteus mirabilis or Serratia
marcescens; Skin and cutaneous infections caused by E. cloacae,
Klebsiella (including K. Pneumoniae, K. oxytroca), P
mirabilis, Morganella morganii, E. coil, Serratia
marcescens, Acinetobacter calcoaceticus or Pseudomonas
aeruginosa; bone and joint infections caused by Enterobacter,
E. coli, K. Pneumoniae, P mirabilis, urinary tract
infections caused by E. coli, Kiebsielia (including K.
Pneumoniae), Morganella morganii, P mirabilis or P
vulgaris, infra-abdominal infections caused by E. coli or K. Pneumoniae;
non-complicated gonorrhoea or pelvic inflammatory disease (PID) caused by
Neisseria gonorrhoeae; septicaemia caused by E. coil, H.
influenza or K. Pneumoniae.
Third generation cephalosporins
have been used together with aminoglycosids in the empirical treatment of
patients with severe Gram-negative sepsis.
A dose of 250 mg IM of ceftriaxone is effective in the treatment of genital
ulcers caused by H. ducreyi and is recommended as an alternative to
erythromycin in this infection treatment, in patients infected by the Human
Immunodeficiency Virus (HIV).
Bacterial Infections caused by Enterobacteriacea
Ceftiaxone and other 3rd generation cephalosporins, are as effective as
aminoglycosids in the treatment of these infections and are associated to
less toxicity. In the begining of severe infections caused by
Enterobacteriacea, many clinicians suggest that 3rd generation
cephalosporins and a large spectrum penicillin should be used together with
an aminoglycosid until the sensitivity tests results are known. Some
clinicians even suggest that ceftriaxone is specially useful as initial
therapy in the treatment of infections known or suspected to be caused by
multi-resistant Enterobacteriacea (pneumonia or nosocomial infections
of urinary tract, septicaemia suspects in neutopenic patients). However, for
the treatment of urinary tract infections without complications, ceftriaxone
use (like other 3rd generation cephalosporins) should not be generalized,
when are available small activity spectrum antibiotics, considered the first
A clinical trial results, randomised and double blind suggest that a single
dose of 50 mg/kg of ceftriaxone IM has an equal efficacy to 40 mg/kg of
amoxicillin during 10 days, in the treatment of odds media in children
between 5 months and 5 years of age. A single dose of ceftriaxone IM can
therefore, be an alternative to oral antibiotics in the treatment of otitis
media, especially in cases where acceptance/collaboraton, from the patient
can be a problem.
Gonorrhoea and Associated Infections
Ceftriaxone is used in the treatment of non-complicated gonorrhea, as well
as other gonococcic infections caused by strains that produce penicillinases
of N. gonorrhoeae (PPNG) or strains that do not produce
penicillinases of this microorganism. Ceftriaxone is considered as a first
choice drug in the treatment of endocervical or rectum uretral infections
caused by N. gonorrhoeae, as well as other gonococcic infections
caused by PPNG.
Non-complicated Gonorrhoea in Adults
A single dose of ceftriaxone IM is one of various therapeutic regimens
effective in the treatment of uretral, endocervical, pharynge or rectal
infections caused by N. gonorrhoeae penicillinase producer or not. A
single doses of 125-250 mg of ceftriaxone IM is recommended for the
treatment of non-complicated gonorrhoea, associated to an anti-infection
regimen effective in Chlamydia infection. Up to now, there are no known
strains of N. gonorrhoeae resistant to ceftriaxone.
Disseminated Gonococcic Infections in Adults
Ceftriaxone IM and IV is recommended as the elective regimen in the initial
treatment of disseminated gonococcic infection (syndrome of dermatitis-gonococcic
Gonococcic Ophtalmia in Adults
Ceftriaxone IM is recommended for the treatment of gonococcic ophtalmia
treatment in the adult. It should be considered the risk of ophtalmic
infection with C. trachomatis, especially in the patients that did not
respond to ceftriaxone therapy.
A single dose of 250 mg of ceftriaxone IM associated td oral doxicyclin or
tetacyclin orais, in adults, in the treatment of acute epididymitis,
sexually transmitted and caused by N. gonorrhoeae and/or C.