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# Ceftriaxone
## Overview
Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic administered intravenously or intramuscularly. It exhibits excellent activity against many Gram-positive and Gram-negative organisms.
## Primary Indications
* Pneumonia
* Meningitis (including Neisseria meningitidis)
* Bacterial sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Gonorrhea (disseminated and uncomplicated)
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1-2 grams IV or IM every 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours (divided into two 2-gram doses every 12 hours).
* **Uncomplicated Gonorrhea:** 500 mg IM once.
* **Disseminated Gonococcal Infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (<7 days):** 25-50 mg/kg IV or IM every 24 hours. Do not exceed 50 mg/kg/day.
* **Infants and Children (>7 days):**
* **General Infections:** 50-100 mg/kg IV or IM every 24 hours, divided into two doses every 12 hours for severe infections.
* **Meningitis:** 100 mg/kg IV every 12-24 hours. Total daily dose should not exceed 4 grams.
## Dose Adjustments
No dose adjustment is necessary for renal or hepatic impairment.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 28 days) receiving IV calcium-containing solutions concurrently due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis (at injection site).
* **Less Common:** Eosinophilia, leukopenia, thrombocytopenia, thrombocytosis, elevated liver enzymes, nausea, vomiting, abdominal pain, headache, dizziness, candidiasis.
* **Rare but Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, biliary sludge/cholelithiasis (especially in neonates), hemolytic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity.
* **Oral Contraceptives:** May reduce efficacy.
* **Probenecid:** May increase ceftriaxone levels.
* **Calcium-Containing Solutions (IV):** Do not mix or administer concurrently with ceftriaxone, especially in neonates, due to potential for life-threatening precipitation.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for diarrhea and signs of *C. difficile* infection.
* Monitor CBC, liver function tests, and renal function periodically, especially with prolonged therapy or in patients with underlying conditions.
* Monitor for signs of biliary sludge or cholelithiasis, particularly in neonates or prolonged therapy.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in many indications.
* IM administration may be painful; consider adding lidocaine to the diluent if appropriate and not contraindicated.
* Ensure adequate hydration to minimize the risk of crystalluria.
* Ceftriaxone penetrates the cerebrospinal fluid well, making it a preferred agent for bacterial meningitis.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and product literature before making clinical decisions. Dosing may vary based on individual patient factors and local protocols.*
