First-lineRocephin
Ceftriaxone
3rd-generation cephalosporin
Single-dose IM cure for gonorrhoea in pregnancy.
IMIV
First-line for
- Gonorrhoea (1 g IM with azithromycin)
- PID outpatient regimen
- Septic arthritis
Mechanism
β-lactam — broad Gram-neg + many Gram-pos cover; long half-life.
“Gonorrhoea: 1 + 1 + 1”
- 1 g IM ceftriaxone
- 1 g oral azithromycin
- 1 test of cure at 2 weeks
Dosing
- Gonorrhoea
- 1 g IM single dose
- PID
- 1 g IM + doxy + metro
Contraindications
- AbsoluteCephalosporin anaphylaxis
- AbsoluteNeonates with hyperbilirubinaemia
- CautionDo NOT co-infuse with calcium IV
Side effects
- Biliary sludge / pseudolithiasis
- Rash
- Eosinophilia
Fetal & maternal notes
- • Safe T1–T3
- • Avoid in neonates with jaundice (bilirubin displacement)
Key interactions
Calcium IV (esp neonate)
AvoidFatal precipitates
Warfarin
Caution↑ INR
Clinical pearls
- 💡 Replace doxycycline in pregnant PID (doxy avoided)
- 💡 Use azithromycin instead for chlamydia coverage
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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