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# Ceftriaxone (Ceftriaxone)
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many gram-positive and gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Meningitis (bacterial)
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Sepsis
* Gonorrhea (uncomplicated)
* Lyme disease (disseminated)
## Adult Dosing
* **General Infections:** 1 to 2 grams IV or IM every 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours (divided into two 2-gram doses every 12 hours).
* **Uncomplicated Gonorrhea:** 500 mg IM once.
* **Disseminated Lyme Disease:** 2 grams IV every 24 hours for 14 to 21 days.
Dosing for specific indications may vary based on severity and local guidelines.
## Pediatric Dosing
* **Neonates (< 2 weeks):** 25 to 50 mg/kg IV every 24 hours. Doses higher than 50 mg/kg are not recommended due to increased risk of bilirubin displacement.
* **Neonates (2 to 4 weeks):** 50 mg/kg IV every 24 hours.
* **Infants and Children (> 1 month):** 50 to 100 mg/kg IV or IM every 24 hours, not to exceed 2 grams daily.
* **Meningitis:** 80 to 100 mg/kg IV every 24 hours, divided into two doses every 12 hours.
Dosing for neonates requires careful consideration of gestational age and postnatal age.
## Dose Adjustments
No dose adjustment is needed for renal impairment. Ceftriaxone is largely cleared by the liver.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving IV calcium-containing solutions. Concurrent administration may lead to precipitation of ceftriaxone-calcium.
## Adverse Effects
* **Common:** Diarrhea, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Biliary pseudolithiasis (especially in children), hypersensitivity reactions (including anaphylaxis), Clostridioides difficile-associated diarrhea, Aplastic anemia, Porphyria, Hemolytic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with high doses.
* **Warfarin:** Ceftriaxone may potentially alter the effect of warfarin. Monitor INR closely.
* **Calcium-containing solutions:** Do not mix or administer concurrently with ceftriaxone, especially in neonates.
## Monitoring
* Assess for signs and symptoms of hypersensitivity.
* Monitor for diarrhea and signs of C. difficile infection.
* Monitor complete blood count (CBC) and liver function tests (LFTs) periodically, especially with prolonged therapy.
* Monitor renal function if co-administered with nephrotoxic agents.
* Monitor for biliary sludge formation in children receiving prolonged therapy.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine if lidocaine is unavailable or contraindicated, though it may cause more pain.
* Due to its long half-life, once-daily dosing is often feasible.
* It is a frequently used agent for empiric therapy of many common infections.
* The risk of kernicterus is increased in jaundiced neonates and those with hypoalbuminemia when ceftriaxone is administered.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local institutional protocols before administering any medication.
