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# 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
* Complicated urinary tract infections (UTIs), including pyelonephritis
* Pneumonia (community-acquired and hospital-acquired)
* Meningitis (bacterial)
* Sepsis
* Gonorrhea (uncomplicated cervical, rectal, or urethral gonorrhea)
* Lyme disease (early and late disseminated)
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours. Daily doses up to 4 grams have been used for severe infections.
* **Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infections, 1 gram IV/IM every 24 hours for 7 days.
* **Lyme Disease:** 2 grams IV every 24 hours for 14 to 28 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30 to 60 minutes before incision.
Dosing for specific indications may vary based on severity and local guidelines.
## Pediatric Dosing
* **Neonates (< 7 days):** 25 to 50 mg/kg IV every 24 hours.
* **Neonates (> 7 days) and Children (< 12 years):** 50 to 100 mg/kg/day IV/IM divided every 12 to 24 hours. Maximum dose is typically 2 grams per day.
* **Children (> 12 years):** Dosing is the same as adults.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
Dosing in neonates requires careful consideration of gestational and postnatal age.
## Dose Adjustments
No dose adjustment is necessary for renal impairment. Ceftriaxone is significantly eliminated by hepatic metabolism.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving calcium-containing IV solutions or infusions due to the risk of ceftriaxone-calcium precipitates.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, rash, and injection site reactions. Less common but serious adverse effects include hypersensitivity reactions (anaphylaxis), C. difficile-associated diarrhea, and cholelithiasis (especially in neonates).
## Key Drug Interactions
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Aminoglycosides:** Potential for additive nephrotoxicity, although data is mixed.
* **Warfarin:** Ceftriaxone may alter the anticoagulant effect of warfarin; monitoring is recommended.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile-associated diarrhea.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing organ dysfunction.
* Monitor for signs of therapeutic efficacy and emergence of resistance.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing.
* It is not recommended for use in neonates receiving calcium-containing solutions due to the risk of fatal precipitation in the lungs and kidneys.
* IM injections are painful; consider lidocaine as a diluent if available and appropriate.
* Ceftriaxone can displace bilirubin from albumin in neonates, potentially increasing the risk of kernicterus. It is contraindicated in hyperbilirubinemic neonates requiring calcium therapy.
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*This information is intended for healthcare professionals. Always verify current prescribing information with the latest official product monograph or reliable drug information resource before making clinical decisions.*
