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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
* Lower respiratory tract infections (e.g., pneumonia)
* Skin and soft tissue infections
* Urinary tract infections (including pyelonephritis)
* Bacterial meningitis
* Sepsis
* Gonorrhea
* Pelvic inflammatory disease
* Osteomyelitis
* Septic arthritis
* Lyme disease (disseminated stages)
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 24 hours. Some severe infections may require 4 grams per day, administered as 2 grams every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose. For disseminated gonococcal infections, 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV/IM within 30-60 minutes prior to incision.
## Pediatric Dosing
Dosing is based on weight and indication, and should be guided by local protocols or infectious disease consultation.
* **Serious Infections:** 50-100 mg/kg/day IV/IM divided every 12 or 24 hours. Maximum daily dose is 4 grams.
* **Meningitis:** 80-100 mg/kg/day IV divided every 12 or 24 hours. Maximum daily dose is 4 grams.
* **Neonates (0-14 days):** 25-50 mg/kg/day IV/IM divided every 24 hours.
* **Neonates (15-28 days):** 50 mg/kg/day IV/IM divided every 12 or 24 hours.
* **Uncomplicated Gonorrhea (children > 8 years and weighing > 45 kg):** 125 mg IM single dose.
## Dose Adjustments
No dose adjustment is typically required for renal impairment. However, if hepatic impairment is also present, doses should not exceed 2 grams daily.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates with hyperbilirubinemia, particularly premature infants, or those requiring calcium-containing intravenous infusions (due to risk of ceftriaxone-calcium precipitates).
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis at the injection site.
* **Less Common:** Nausea, vomiting, eosinophilia, leukopenia, thrombocytopenia, headache, dizziness.
* **Rare/Serious:** Clostridium difficile-associated diarrhea, anaphylaxis, Stevens-Johnson syndrome, hepatic dysfunction, biliary sludge/cholelithiasis, renal dysfunction, Jarisch-Herxheimer reaction (with Lyme disease treatment).
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with high doses.
* **Probenecid:** May increase and prolong ceftriaxone serum levels.
* **Oral anticoagulants (e.g., warfarin):** Ceftriaxone may alter platelet function and increase the risk of bleeding.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of precipitate formation. Avoid concurrent administration in adults as well, especially in IV lines.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for effectiveness of treatment (resolution of infection).
* Monitor for diarrhea and signs of C. difficile infection.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or receiving other nephrotoxic/hepatotoxic agents.
* Monitor for signs of phlebitis with IV administration.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in many adult indications.
* Intramuscular injection is often preferred for outpatient management of certain infections when IV access is not feasible.
* Ceftriaxone can displace bilirubin from albumin; therefore, it is contraindicated in neonates with hyperbilirubinemia.
* Preparation of ceftriaxone solutions should be done carefully, and concurrent administration with calcium-containing solutions should be avoided to prevent precipitation.
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*This information is intended for healthcare professionals. Always verify current prescribing information and local protocols before administering any medication.*
