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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.
## Primary Indications
* Bacterial meningitis (including Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae)
* Pneumonia (community-acquired and hospital-acquired)
* Skin and skin structure infections
* Urinary tract infections, including pyelonephritis
* Pelvic inflammatory disease
* Complicated intra-abdominal infections
* Sepsis
* Gonorrhea (disseminated and uncomplicated)
* Prophylaxis for surgical site infections
## Adult Dosing
* **General infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours, divided into two doses (2 grams every 12 hours).
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Disseminated gonococcal infection:** 1 gram IV or IM every 24 hours for 7 days.
* **Meningitis:** 2 grams IV every 12 hours.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Avoid concomitant IV calcium-containing solutions.
* **Neonates (15-28 days):** 50 mg/kg IV every 24 hours. Avoid concomitant IV calcium-containing solutions.
* **Infants and Children (>28 days to 12 years):**
* **General infections:** 50-100 mg/kg IV or IM every 24 hours.
* **Severe infections:** Up to 150 mg/kg/day IV, divided every 12-24 hours (maximum 8 grams/day).
* **Meningitis:** 100 mg/kg IV every 12-24 hours (maximum 4 grams/day).
* **Children >12 years:** Same as adult dosing.
## Dose Adjustments
No dose adjustment is necessary for renal or hepatic impairment due to extensive biliary and renal excretion.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactams.
* Neonates (<41 weeks gestational age) who are premature and jaundiced, or those with hypoalbuminemia, are at increased risk of bilirubin encephalopathy.
* Concomitant use of IV calcium-containing solutions with ceftriaxone in neonates, regardless of age or duration of IV administration, due to the risk of precipitation in pulmonary and renal vasculature.
## Adverse Effects
* **Common:** Diarrhea, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Biliary sludge/cholelithiasis (especially in neonates), anaphylaxis, Clostridioides difficile-associated diarrhea, hemolytic anemia, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Probenecid:** May increase ceftriaxone levels.
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together, especially in severe infections. Monitor renal function.
* **Warfarin:** Ceftriaxone may alter the effect of warfarin; monitor INR.
* **Calcium-containing solutions:** See Contraindications section for neonates. In adults, administration through the same IV line or Y-site requires flushing with a compatible diluent between administrations.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (baseline and periodically in prolonged therapy or in patients with known impairment).
* Complete blood count (CBC) with differential and platelet count.
* Biliary ultrasound if symptomatic for sludge or stones.
* INR if co-administered with warfarin.
## Clinical Pearls
* Ceftriaxone is typically administered once daily, which improves patient compliance.
* For IM administration, lidocaine can be used as the diluent to reduce injection pain.
* The maximum recommended daily dose is generally 4 grams, except in specific severe situations like meningitis where higher doses may be considered per institutional guidelines.
* Always reconstitute and dilute according to manufacturer's instructions.
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This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.
