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# Ceftriaxone (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
* Hospital-acquired pneumonia
* Complicated urinary tract infections (UTIs), including pyelonephritis
* Uncomplicated UTIs
* Skin and soft tissue infections
* Biliary tract infections, including cholecystitis and cholangitis
* Intra-abdominal infections
* Meningitis (bacterial)
* Sepsis
* Gonorrhea (uncomplicated)
* Prophylaxis for surgical site infection
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously or intramuscularly every 24 hours.
* **Severe Infections:** Doses up to 4 grams intravenously per day have been used, typically divided into two doses (2 grams every 12 hours). However, higher doses are generally not recommended due to potential for increased adverse effects without clear benefit.
* **Uncomplicated Gonorrhea:** 500 mg intramuscularly as a single dose. For disseminated gonococcal infection, refer to specific guidelines.
* **Meningitis:** 2 grams intravenously every 12 hours.
* **Surgical Prophylaxis:** 1 to 2 grams intravenously 30 to 60 minutes before surgical incision.
## Pediatric Dosing
Dosing varies significantly by indication and patient weight. Consult specific pediatric guidelines.
* **General Infections:** 50 to 100 mg/kg/day intravenously or intramuscularly, divided into one or two doses every 12 or 24 hours. Maximum daily dose is typically 2 grams.
* **Meningitis:** 100 mg/kg/day intravenously, divided every 12 hours. Do not exceed the adult maximum of 4 grams/day.
* **Neonates (0-14 days):** 25 to 50 mg/kg/day intravenously, once every 24 hours.
* **Neonates (15-28 days):** 50 mg/kg/day intravenously, divided every 12 hours.
* **Note:** Ceftriaxone is **contraindicated** in neonates < 41 weeks post-conceptual age receiving IV calcium-containing solutions due to risk of precipitation.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, as ceftriaxone is largely eliminated by hepatic metabolism and biliary excretion. However, in severe hepatic dysfunction with significant renal impairment, caution and monitoring may be warranted.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* **Neonates:** Ceftriaxone is contraindicated in premature neonates and full-term neonates (≤ 28 days old) receiving concomitant treatment with or intended for treatment with calcium-containing intravenous products, including continuous parenteral nutrition containing calcium.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, elevated liver enzymes.
* **Serious:**
* *Clostridioides difficile*-associated diarrhea (CDAD)
* Anaphylaxis
* Seizures (rare, typically associated with high doses)
* Biliary sludge/cholelithiasis (especially in children)
* Hemolytic anemia (rare)
* Renal or hepatic injury (rare)
## Key Drug Interactions
* **Calcium-containing products:** Avoid concurrent administration of intravenous ceftriaxone and calcium-containing solutions or diluents, especially in neonates, due to risk of fatal precipitation in lungs and kidneys. Separate administration by at least 48 hours if both are essential.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR closely and adjust warfarin dose as needed.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations, but this is not usually clinically significant.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of *C. difficile*-associated diarrhea.
* Monitor renal and hepatic function, and complete blood counts periodically during prolonged therapy.
* Monitor for biliary sludge or symptoms of cholecystitis, especially in pediatric patients.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing, which can improve patient adherence.
* The intramuscular route is often preferred for outpatient parenteral antibiotic therapy (OPAT) due to ease of administration.
* Always reconstitute and dilute according to manufacturer instructions. Use compatible diluents.
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*This information is intended for healthcare professionals and does not substitute for comprehensive drug information resources or clinical judgment. Always verify current prescribing information and consult relevant guidelines before initiating or modifying therapy.*
