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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
* Pneumonia (community-acquired, hospital-acquired)
* Bacterial meningitis
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Preoperative prophylaxis
## Adult Dosing
* **General:** 1-2 grams IV/IM every 12 to 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours.
* **Uncomplicated gonorrhea:** 500 mg IM single dose.
* **Surgical prophylaxis:** 1-2 grams IV within 60 minutes prior to incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV/IM every 24 hours. Avoid IV doses > 50 mg/kg to reduce risk of bilirubin displacement.
* **Neonates (15-28 days) and Children:** 50-100 mg/kg IV/IM every 12 to 24 hours.
* **Severe infections/Meningitis:** Up to 100 mg/kg/day IV divided every 12-24 hours, not to exceed 4 grams/day.
## Dose Adjustments
No dose adjustment is generally required for renal or hepatic impairment due to high biliary and renal excretion. However, caution may be advised in severe renal impairment or severe hepatic impairment with concomitant renal dysfunction.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (term and premature) with hyperbilirubinemia or who are receiving calcium-containing solutions IV due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, injection site reactions (pain, phlebitis).
* **Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, seizures, cholelithiasis (biliary sludging), eosinophilia, thrombocytopenia, leukopenia, hemolytic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity (monitor renal function).
* **Probenecid:** May increase and prolong ceftriaxone serum levels.
* **Oral anticoagulants:** May enhance the effect of anticoagulants (monitor INR).
* **Calcium-containing solutions/products (IV):** Contraindicated in neonates. Potential for precipitation in IV lines and in the body.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function, especially in patients with pre-existing impairment or those on concurrent nephrotoxic agents.
* Electrolytes.
* For *C. difficile* infection if diarrhea develops.
* Injection site for signs of phlebitis or irritation.
## Clinical Pearls
* Ceftriaxone is not recommended for use in preterm neonates and term neonates with hyperbilirubinemia due to the risk of bilirubin encephalopathy.
* Concurrent administration with calcium-containing IV solutions is contraindicated in all patient populations due to risk of precipitate formation. If coadministration is necessary, administer sequentially and flush IV lines between administrations.
* Intramuscular administration may be painful; consider adding lidocaine to the diluent if available and appropriate.
* Therapy duration depends on the type and severity of infection.
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**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always consult the most current prescribing information and guidelines, and exercise professional judgment when making clinical decisions.
