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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
* Community-acquired pneumonia
* Bacterial meningitis
* Acute bacterial exacerbations of chronic bronchitis
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Skin and soft tissue infections
* Bone and joint infections
* Sepsis
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams (g) intravenously (IV) or intramuscularly (IM) every 24 hours (q24h).
* **Severe infections:** Up to 4 g IV q24h, typically divided as 2 g q12h.
* **Uncomplicated gonorrhea:** 250 milligrams (mg) IM as a single dose.
* **Surgical prophylaxis:** 1 to 2 g IV 30 to 60 minutes prior to incision.
Dosing may vary based on the specific indication and severity of infection, and local protocols should be consulted.
## Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg IV q24h. Do not exceed 50 mg/kg/day. Avoid concurrent IV calcium-containing solutions.
* **Neonates (15-28 days):** 25 to 75 mg/kg IV q24h.
* **Pediatric patients (>28 days to 12 years or weight <50 kg):** 50 to 100 mg/kg IV or IM q24h. The total daily dose should not exceed 2 g.
* **Pediatric patients (>12 years or weight >50 kg):** Dosing is the same as adults.
* **Meningitis:** Higher doses may be used, typically 100 mg/kg/day IV divided q12h (maximum 4 g/day).
Dosing for pediatric patients requires careful consideration of age, weight, and indication. Specific guidelines should be followed.
## Dose Adjustments
No dose adjustment is typically required in patients with renal or hepatic impairment. However, caution and monitoring are advised in severe impairment, particularly if co-occurring.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving IV calcium-containing solutions or products administered orally with calcium supplements.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis, eosinophilia, thrombocytosis.
* **Less Common:** Nausea, vomiting, abdominal pain, leukopenia, anemia, renal calculi (rare), gallbladder sludge.
* **Rare:** Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome, Clostridioides difficile-associated diarrhea.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity, especially in patients with renal dysfunction.
* **Warfarin:** May decrease the efficacy of warfarin; monitor INR closely.
* **Probenecid:** Can increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions/products:** Contraindicated in neonates due to risk of precipitation in lungs and kidneys.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (especially in severe impairment).
* Blood counts.
* Prothrombin time/INR when used with warfarin.
* Injection site for signs of phlebitis.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing in most cases.
* IM administration may be painful; consider lidocaine as a diluent for IM injections.
* Discontinue if hypersensitivity reaction occurs.
* Due to the risk of biliary sludging, prolonged therapy may warrant ultrasound monitoring of the gallbladder.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current official prescribing information and relevant clinical guidelines for complete and up-to-date details before making any treatment decisions.
