Ceftriaxone kills bacteria by stopping them from building their cell walls. It holds up against some of the enzymes, called beta-lactamases, that bacteria use to destroy antibiotics like it. Bacteria can still resist it by using those enzymes, by changing the proteins it targets, or by letting less of it inside.
It reaches the lining of the brain when that lining is inflamed, which is why it can treat meningitis. It stays in the body long enough to be given once or twice a day, and people should start to feel better within the first few days. It leaves the body through both the urine and the bile, so people with kidney failure usually do not need a smaller amount. It can bind with calcium to form solid particles, which explains the gallbladder sludge, kidney stones, and deadly deposits in newborns given calcium fluids.