India · Paediatric mg/kg · Neonatal · Adult · Meningitis · Sepsis · Typhoid · CAP · UTI · Monocef · Oframax
✓ Streptococcus pneumoniae (meningitis, CAP)
✓ Neisseria meningitidis / gonorrhoeae
✓ H. influenzae
✓ Salmonella typhi (typhoid)
✓ E. coli, Klebsiella (UTI, sepsis)
✗ Pseudomonas (use ceftazidime)
✗ MRSA · Enterococcus · Anaerobes
✗ Listeria (neonatal meningitis — add ampicillin)
| Indication | Paediatric dose | Adult dose | Frequency | Duration |
|---|---|---|---|---|
| Bacterial meningitis | 100 mg/kg/day (max 4g) | 2g every 12 hours | BD (q12h) for meningitis | 7–10d (pneumococcal); 7d (meningococcal) |
| Sepsis / severe infection | 50–80 mg/kg/day (max 4g) | 2g once daily | OD or BD | 7–14 days (guided by clinical response) |
| Typhoid — severe / IV | 75 mg/kg/day (max 2.5g) | 2–3g once daily | Once daily | 10–14 days |
| Community pneumonia (CAP) | 50 mg/kg/day (max 2g) | 1–2g once daily | Once daily | 5–7 days |
| Complicated UTI | 50 mg/kg/day (max 2g) | 1–2g once daily | Once daily | 10–14 days |
| Gonorrhoea (single dose) | 125–250 mg IM (single) | 500mg IM (single) — WHO 2016 | Single dose | Single dose |
| Surgical prophylaxis | 50 mg/kg (max 2g) | 1–2g | Single dose 30–60 min pre-incision | Single dose |
| Neonatal sepsis (term) | 50 mg/kg OD | — | Once daily | 10–14 days |
| Neonatal meningitis | 50 mg/kg BD | — | Every 12 hours | 21 days |
Ceftriaxone is a third-generation cephalosporin and one of the most widely used IV/IM antibiotics in Indian hospitals. It provides broad Gram-negative and Gram-positive coverage with excellent tissue penetration, including the central nervous system — making it first-line for bacterial meningitis in India. Its long half-life (6–9 hours) allows once-daily dosing for most indications, reducing nursing workload and improving compliance. Available as Monocef and Oframax in 250mg, 500mg, 1g, and 2g vials.
Bacterial meningitis requires the highest ceftriaxone doses because adequate CSF drug levels are essential and the blood-brain barrier limits CNS penetration. Paediatric dose: 100 mg/kg/day — given as 50 mg/kg every 12 hours. Adult dose: 2g every 12 hours. Always give dexamethasone 0.15 mg/kg IV before or with the first antibiotic dose in suspected bacterial meningitis — this significantly reduces hearing loss (particularly in H. influenzae meningitis) and meningeal inflammation. If Listeria monocytogenes is possible (neonates, immunocompromised, elderly), add ampicillin — ceftriaxone does not cover Listeria.
Ceftriaxone is contraindicated in neonates receiving calcium-containing IV fluids simultaneously — including total parenteral nutrition (TPN) and Ringer's lactate. Ceftriaxone-calcium precipitates form in the lungs and kidneys and have caused neonatal deaths. Use cefotaxime instead in neonates requiring concurrent calcium administration. This is a critical patient safety issue — the interaction is not relevant in older children and adults at the doses used clinically.
For IM ceftriaxone, the vial should be reconstituted with 1% lignocaine (lidocaine) solution (not water) to significantly reduce injection pain. For a 1g vial: add 3.5ml of 1% lignocaine. For a 500mg vial: add 2ml of 1% lignocaine. Inject deep IM into the upper outer gluteal quadrant. Never exceed 1g per injection site — if 2g is needed IM, give 1g at each gluteal site. Never reconstitute with lignocaine for IV use.
For uncomplicated typhoid in ambulatory patients, azithromycin oral remains the first-line agent in India (see Azithromycin page). Ceftriaxone IV is used when: the patient cannot take oral medications (vomiting), severe typhoid with complications (intestinal perforation, hepatitis, encephalopathy), failed oral azithromycin, or when confirmed ceftriaxone-sensitive isolate on culture. Duration: 10–14 days IV for severe cases.