Intramuscular Administration of Ceftriaxone

Recommended Injection Sites

The Centers for Disease Control and Prevention recommends the deltoid muscle as the preferred site for intramuscular injections in adolescents and adults, including 17-year-olds 1, 2
The anterolateral thigh can also be used as an alternative site for intramuscular injections in adolescents 1, 3
The American Heart Association advises against using the buttock for administration of ceftriaxone or other medications due to potential risk of injury to the sciatic nerve and decreased drug absorption 1, 4

The Centers for Disease Control and Prevention recommends a needle size of 22-25 gauge and 1-1½ inches in length for intramuscular injections in adolescents to ensure proper muscle penetration 1
When administering 2 grams of ceftriaxone intramuscularly, the dose may need to be divided and administered at two different sites due to the volume 4
For HACEK microorganism infections, the American Heart Association recommends ceftriaxone 2 grams per 24 hours can be administered intramuscularly as a single daily dose 4

For adolescents aged 12-18 years, the Centers for Disease Control and Prevention recommends using the deltoid muscle if the muscle mass is adequate; otherwise, the anterolateral thigh is recommended 1
Proper technique is essential to prevent inadvertent subcutaneous injection or injection into deep fat tissue when administering intramuscular injections to adolescents 1, 5
Although aspiration has traditionally been recommended, current evidence from the Centers for Disease Control and Prevention suggests this may not be necessary 1, 5

The anterolateral aspect of the thigh is the appropriate location for intramuscular ceftriaxone injection in an 18‑month‑old child. 6, 7

The anterolateral thigh is the preferred and recommended site for intramuscular injections in infants and young children, including those aged 18 months. 6, 7

The American Academy of Pediatrics and the Centers for Disease Control and Prevention explicitly endorse the anterolateral thigh as the injection site for vaccines and medications in this age group. 6, 7

The deltoid muscle is not suitable for intramuscular injection in an 18‑month‑old child because it lacks sufficient muscle mass; it is recommended only for children aged 3 years and older. 6, 7