Third-generation cephalosporins
ATC code: J01DD04 (Ceftriaxone)
Brand names
Rocephin, Ceftriaxona Normon, Ceftriaxona Kabi
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.
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 ( 500 mg or ) or a respiratory fluoroquinolone (). Treatment duration 5-7 days with typical response. ICU patients receive 2 g/day.
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.
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Acceptable in pregnancy when parenteral therapy is needed (pyelonephritis, severe pneumonia, gonorrhea). FDA category B – no teratogenic effects reported.
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.
Ceftriaxone is evaluated for the following indications with varying evidence strength: Community-acquired pneumonia (evidence tier A), Acute viral upper respiratory infection (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.
FDA category B. Acceptable in pregnancy when parenteral therapy is needed (pyelonephritis, severe pneumonia, gonorrhea). FDA category B – no teratogenic effects reported.
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.