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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.
## Primary Indications
* Community-acquired pneumonia
* Bacterial meningitis
* Skin and soft tissue infections
* Urinary tract infections (including pyelonephritis)
* Pelvic inflammatory disease
* Sepsis
* Gonorrhea (disseminated and uncomplicated)
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 24 hours. Doses can be divided every 12 hours for severe infections, with a maximum daily dose of 4 grams.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose.
* **Disseminated Gonorrhea:** 1 gram IV or IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV administered 30-60 minutes before incision.
## Pediatric Dosing
Dosing varies significantly by indication and weight. Consult specific pediatric guidelines or institutional protocols.
* **General Infections:** Doses typically range from 50-100 mg/kg/day IV or IM, divided every 12-24 hours. Maximum daily dose is typically 2 grams.
* **Meningitis:** 100 mg/kg/day IV, divided every 12-24 hours. Maximum daily dose is typically 4 grams.
* **Neonates (0-14 days):** Dosing is generally lower, often 25-50 mg/kg/day IV or IM, divided every 24 hours, to avoid kernicterus.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment when used within standard dosing ranges. However, doses should not exceed the maximum recommended daily dose.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Concurrent use with intravenous calcium-containing solutions in neonates (risk of precipitates).
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis (at injection site).
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (anaphylaxis), biliary sludge or pseudolithiasis, hematologic abnormalities (eosinophilia, leukopenia, thrombocytopenia), renal impairment, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used concurrently, particularly in severe infections.
* **Warfarin:** Ceftriaxone may potentiate the effect of warfarin, leading to an increased risk of bleeding. Monitor INR closely.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of fatal precipitates in lungs and kidneys. Avoid coadministration in adults unless separated by at least 48 hours.
## Monitoring
* Signs and symptoms of infection (fever, white blood cell count, inflammatory markers).
* Signs of hypersensitivity reactions.
* Bowel function, for *C. difficile* infection.
* Renal and hepatic function periodically, especially with prolonged therapy or in patients with pre-existing impairment.
* Coagulation parameters if patient is on anticoagulants or has risk factors for bleeding.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine if necessary, though lidocaine reduces injection site pain.
* The long half-life allows for once-daily dosing in many indications.
* Due to its biliary excretion, ceftriaxone can cause biliary pseudolithiasis, especially in children and with higher doses. This is usually asymptomatic and resolves after discontinuation.
* Ensure adequate hydration to minimize the risk of crystalluria.
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This information is intended for healthcare professionals. Please consult the most current prescribing information and institutional protocols for definitive guidance.
