A 2019 review on antimicrobial desensitization describes the process as inducing a temporary state of drug tolerance that reverses within hours to days after discontinuation, requiring repeat desensitization for future courses if therapy is interrupted. For ceftriaxone, the review references an intravenous cephalosporin desensitization protocol using incremental doses administered every 15 minutes, reaching completion in approximately 2 hours and 15 minutes, followed by a 30-minute observation period before administration of the full therapeutic dose. Refer to Table 1 for the full desensitization protocol. [1], [2]
According to a 2023 Baptist Health antibiotic graded dose challenge and desensitization protocol, intravenous ceftriaxone desensitization involves escalating doses administered every 15 minutes, each infused over 15 minutes and followed immediately by the next scheduled dose. After the final desensitization dose, the patient is observed for 15 to 30 minutes; if tolerated, the full therapeutic ceftriaxone dose is administered. The guideline also notes that desensitization induces a temporary state of tolerance that requires continued exposure, and if the antibiotic is not given for more than 24 hours, desensitization must be repeated. Refer to Table 2 for the full desensitization protocol. [3]
A 2019 review evaluated cephalosporin hypersensitivity and management approaches and describes rapid drug desensitization protocols using very low starting doses, typically 1/10,000th to 1/1,000,000th of the target dose, with dose escalation in doubling steps at minimum 15-minute intervals between steps. The review notes that desensitization is performed once for the treatment course, after which subsequent daily cephalosporin doses are administered as standard therapy without repeating the protocol, indicating that continued regular dosing is used to maintain the desensitized state. [4]