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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative organisms. It is administered intravenously or intramuscularly.
## Primary Indications
* Complicated urinary tract infections (UTIs)
* Pneumonia (including community-acquired and hospital-acquired)
* Meningitis
* Sepsis
* Skin and soft tissue infections
* Gonorrhea
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe Infections:** Doses up to 4 grams IV every 24 hours may be administered.
* **Surgical Prophylaxis:** 1 to 2 grams IV or IM given 30 to 60 minutes before incision.
* **Gonorrhea:** 500 mg IM as a single dose (1 gram IM for disseminated gonococcal infections).
Dosing frequency and duration are dependent on the type and severity of infection, and local institutional protocols.
## Pediatric Dosing
Dosing varies significantly by age, weight, and indication.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours; maximum 4 grams/day. May increase to 120 mg/kg/day divided every 8 to 12 hours if indicated.
* **Serious Infections:** 50 to 100 mg/kg/day IV divided every 12 to 24 hours; maximum 4 grams/day.
* **Uncomplicated Gonorrhea (age 1 month to 12 years):** 125 mg IM as a single dose.
* **Neonates (0-14 days):** 25 to 50 mg/kg/day IV divided every 24 hours. Avoid higher doses due to risk of kernicterus.
Specific pediatric dosing should be guided by reliable pediatric drug references and clinical judgment.
## Dose Adjustments
No dose adjustment is typically required for renal impairment. Ceftriaxone is primarily eliminated by hepatic metabolism and biliary excretion. In severe hepatic impairment, particularly when combined with renal impairment, dosing may need to be considered, though often no adjustment is made.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 28 days of age) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site.
* **Serious:** Clostridioides difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), biliary sludge or stones (especially in children), eosinophilia, leukopenia, thrombocytopenia, transient elevations in liver enzymes.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used concurrently, particularly in patients with renal dysfunction.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions/products:** Life-threatening precipitation can occur in neonates (and caution is advised in other patients). Do not mix or administer concurrently via the same IV line.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for therapeutic response (e.g., resolution of fever, clinical improvement).
* Monitor for adverse effects, particularly diarrhea, rash, and signs of superinfection.
* Consider monitoring liver function tests and renal function, especially with prolonged therapy or in patients with pre-existing hepatic/renal disease.
* Biliary sludge monitoring may be considered in pediatric patients or those on prolonged therapy.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in most cases, which improves patient compliance.
* When administered IM, lidocaine should be used as the diluent to minimize pain.
* Ceftriaxone is NOT considered a drug of choice for *Listeria monocytogenes* meningitis.
* Ensure adequate hydration to reduce the risk of crystalluria.
**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines for definitive patient care decisions.
