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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
* Bacterial meningitis
* Community-acquired pneumonia
* Skin and skin structure infections
* Urinary tract infections (including pyelonephritis)
* Pelvic inflammatory disease
* Disseminated gonococcal infections
* Sepsis
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1-2 grams IV or IM every 24 hours.
* **Severe Infections/Meningitis:** Up to 4 grams IV daily, divided every 12 hours. Maximum dose is 4 grams daily.
* **Surgical Prophylaxis:** 1-2 grams IV or IM as a single dose 30-60 minutes before surgery.
* **Gonorrhea:**
* Uncomplicated: 500 mg IM as a single dose.
* Disseminated/Pharyngeal/Rectal: 1 gram IM or IV every 24 hours for 7 days.
Dosing frequency and duration are dependent on the infection type and severity.
## Pediatric Dosing
Dosing is weight-based and depends on the indication and severity of infection. Actual dosing may vary based on local protocols and specific clinical guidelines.
* **Meningitis:** 100 mg/kg IV daily, divided every 12 hours. Maximum 4 grams daily.
* **Serious Infections (non-meningitis):** 50-100 mg/kg IV or IM daily, divided every 12 or 24 hours. Maximum 4 grams daily.
* **Uncomplicated Gonorrhea:** 125 mg IM as a single dose.
* **Neonates (0-14 days):** 25-50 mg/kg IV or IM every 24 hours.
* **Neonates (15-28 days) and Infants:** 50-75 mg/kg IV or IM every 24 hours.
## Dose Adjustments
No dose adjustment is generally required for renal impairment. Ceftriaxone is primarily eliminated by biliary excretion. In patients with severe hepatic impairment and significant renal impairment, monitor drug concentrations if prolonged therapy is anticipated, though dose reduction is not typically necessary.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (less than 28 days of gestational age) receiving intravenous calcium-containing solutions or infusions, due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis at injection site, eosinophilia, thrombocytosis.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludge or pseudolithiasis (especially in pediatrics), Stevens-Johnson syndrome, anaphylaxis, hemolytic anemia, Agranulocytosis, Pancreatitis.
## Key Drug Interactions
* **Calcium-containing solutions:** Co-administration in neonates can cause potentially fatal precipitation in lungs and kidneys.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin, leading to increased INR. Monitor INR closely.
* **Aminoglycosides:** Increased risk of nephrotoxicity and ototoxicity when used together, particularly in patients with renal impairment.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea, particularly *C. difficile*-associated diarrhea.
* Monitor for signs of biliary sludge or pseudolithiasis, especially in pediatric patients with prolonged treatment or high doses.
* Monitor coagulation parameters if patient is on anticoagulants.
* Monitor renal and hepatic function, though routine monitoring is not typically required unless clinically indicated.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing for most indications.
* It is effective in treating Lyme disease.
* For intramuscular administration, lidocaine may be used as a diluent to reduce injection site pain.
* Avoid concurrent use with calcium-containing IV fluids in all patients, especially neonates, due to precipitation risk.
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*Disclaimer: This information is intended for clinical pharmacy professionals and should not replace professional judgment. Always verify current prescribing information with the official product monograph or other reliable resources before making any clinical decisions.*
