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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against gram-positive and gram-negative bacteria.
## Primary Indications
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Acute bacterial meningitis (particularly effective against *Neisseria meningitidis*)
* Uncomplicated gonorrhea
* Disseminated gonococcal infections
* Pelvic inflammatory disease
* Surgical prophylaxis
* Febrile neutropenia (in combination with other agents)
* Bacterial sepsis
## Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours (given as 2 grams every 12 hours).
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV/IM 30-60 minutes before incision.
## Pediatric Dosing
Dosing varies significantly by indication and age/weight. Pediatric dosing should be guided by specific institutional protocols or expert consultation.
* **Meningitis (≥ 1 month):** 100 mg/kg IV every 24 hours (or 50 mg/kg every 12 hours), not to exceed 4 grams/day.
* **Other serious infections (≥ 1 month):** 50-100 mg/kg IV/IM every 24 hours, not to exceed 4 grams/day.
* **Neonates (< 2 weeks):** 25-50 mg/kg IV every 24 hours.
**Note:** Ceftriaxone is contraindicated in neonates < 41 weeks post-conception (gestational age + postnatal age) receiving IV calcium-containing solutions or infusions.
## Dose Adjustments
No dose adjustment is necessary for renal or hepatic impairment. However, caution and monitoring are advised in severe impairment.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactams.
* Neonates (term and preterm) requiring concurrent treatment with calcium-containing IV solutions.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludge/cholelithiasis (especially in neonates and prolonged therapy), hemolytic anemia, Stevens-Johnson syndrome, anaphylaxis.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity and ototoxicity; monitor levels.
* **Warfarin:** Ceftriaxone may decrease vitamin K production, potentially increasing INR; monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of precipitation in lungs and kidneys.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count (CBC).
* Signs of hypersensitivity reactions.
* For neonates: Monitor for signs of biliary precipitation.
## Clinical Pearls
* Ceftriaxone can be administered IV or IM. IM injections may be painful; consider lidocaine as a diluent if available and appropriate.
* The long half-life allows for once-daily dosing, simplifying administration.
* Precipitation in the gallbladder can occur, particularly in neonates and with prolonged therapy, and may be symptomatic or asymptomatic. Discontinuation may be necessary if symptomatic.
* Ceftriaxone is a preferred agent for empiric treatment of meningitis due to excellent CNS penetration.
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*This information is intended for clinical use and does not replace a thorough review of the full prescribing information or consultation with a pharmacist. Always verify current prescribing information with the manufacturer's product monograph or other reliable sources.*
