Ceftriaxone
Rocephin
3rd-generation cephalosporin
β-lactam cell-wall inhibitor; broad gram-negative + good CSF penetration. Long half-life → once-daily.
Indications
- •Community-acquired pneumonia, meningitis, pyelonephritis, gonorrhea, SBP prophylaxis
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Typical | 1–2 g IV daily (2 g q12h for meningitis) | — |
Pharmacokinetics
Long half-life ~6–9 h → once-daily. Dual biliary + renal elimination (no renal adjustment).
Side effects
- !Biliary sludge/pseudolithiasis
- !Kernicterus in neonates (displaces bilirubin)
- !Calcium co-precipitation (fatal in neonates)
- !Allergy
Contraindications
- ×Neonates (esp. hyperbilirubinemia or receiving IV calcium)
- ×Cephalosporin allergy
Clinical pearls
- ★CONTRAINDICATED in neonates with calcium-containing IV fluids (fatal ceftriaxone-calcium precipitates) + causes kernicterus.
- ★No renal dose adjustment (biliary + renal elimination) — convenient in renal failure.
Other drugs in Antibiotics
- Cefazolin
β-lactam — inhibits bacterial cell wall PBPs.
- Vancomycin
Inhibits cell wall synthesis (binds D-Ala-D-Ala). Active against MRSA + gram-positives.
- Clindamycin
Binds 50S ribosomal subunit, blocks peptide-bond formation. Bacteriostatic against most organisms; bactericidal against susceptible streptococci. Excellent activity against anaerobes and gram-positive cocci including community-acquired MRSA.
- Gentamicin
Binds 30S ribosomal subunit, causes misreading of mRNA → defective bacterial protein synthesis. Bactericidal, concentration-dependent killing. Synergy with cell-wall agents (β-lactams, vancomycin) for gram-positive endocarditis.
- Cefuroxime
β-lactam — inhibits cell-wall synthesis (PBP binding). 2nd-gen: gram-positive + expanded gram-negative.
- Cefepime
β-lactam cell-wall inhibitor. Broad gram-negative (incl. Pseudomonas) + gram-positive coverage.
- Cefotetan
β-lactam; adds anaerobic (B. fragilis) coverage → colorectal/gynecologic prophylaxis.
- Cefotaxime
β-lactam cell-wall inhibitor. Broad gram-negative + CNS penetration.
Browse all classes: /reference/drugs
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
