Ceftriaxone (Rocephin) is an intravenous/intramuscular third generation cephalosporin that provides decent aerobic gram positive coverage (ie, pneumococcus although bacterial resistance is growing) but wonderful gram negative coverage against organisms like E. coli, Klebsiella, H. flu, and Proteus. Anaerobic bacteria and Pseudomonas are NOT covered by ceftriaxone.

As an intensivist, I use this antibiotic in a myriad of clinical situations ranging from spontaneous bacterial peritonitis (SBP) prophylaxis and community acquired pneumonia to genitourinary infections and meningitis (even late Lyme disease involving the central nervous system as ceftriaxone as penetrates the cerebrospinal fluid very well).

Similar to cefepime, ceftriaxone can also cause encephalopathy and altered mentation. Additionally, one must be aware of possible hepatobiliary impairment due to biliary sludging and cholecystitis.

My favorite aspect of using ceftriaxone is that it can usually be dosed once-a-day (a key exception being meningeal dosing which is twice daily).

Drop me a comment below with questions! 🙂

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