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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
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Skin and skin structure infections
* Urinary tract infections
* Bacterial meningitis
* Sepsis
* Gonococcal infections
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously or intramuscularly every 24 hours.
* **Severe Infections:** May increase to 4 grams intravenously every 24 hours.
* **Meningitis:** 2 grams intravenously every 12 hours.
* **Uncomplicated Gonococcal Infections:** 500 mg intramuscularly as a single dose.
* **Disseminated Gonococcal Infections:** 1 gram intravenously or intramuscularly every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams intravenously or intramuscularly 30 to 120 minutes prior to incision.
## Pediatric Dosing
* **Premature infants (≤ 7 days):** 20-50 mg/kg intravenously every 48 hours.
* **Full-term infants and children (> 7 days to 12 years):** 50-100 mg/kg intravenously or intramuscularly every 24 hours, not to exceed 2 grams/day.
* **Children with meningitis:** 80-100 mg/kg intravenously every 24 hours, not to exceed 4 grams/day.
* **Neonates (0-28 days) with serious infections (excluding meningitis):** Dosing is complex and often requires consultation with a pediatric infectious disease specialist. Common regimens include 25-50 mg/kg intravenously every 24 hours or every 12 hours depending on the indication and severity. **Note:** Ceftriaxone is contraindicated in hyperbilirubinemic neonates and those requiring calcium-containing intravenous solutions.
## Dose Adjustments
No dose adjustment is typically required for renal impairment. However, in patients with severe renal impairment (CrCl < 10 mL/min) and without concomitant hepatic impairment, the total daily dose should not exceed 2 grams. If both renal and hepatic function are impaired, doses should not exceed 2 grams every 48 hours.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (especially premature infants) receiving concomitant intravenous calcium-containing solutions due to risk of precipitation.
## Adverse Effects
* Diarrhea
* Nausea, vomiting
* Rash, pruritus
* Eosinophilia, leukopenia, thrombocytosis
* Phlebitis at injection site
* Biliary sludge or cholelithiasis (especially with prolonged use)
* Hypoprothrombinemia (rare)
* Aplastic anemia (very rare)
## Key Drug Interactions
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of life-threatening precipitation in lungs and kidneys. Can also precipitate in IV lines and infusion pumps in adults.
* **Aminoglycosides:** Potential for additive nephrotoxicity or antagonism (though often used synergistically in certain severe infections, monitor closely).
* **Warfarin:** Ceftriaxone may decrease vitamin K availability, potentially increasing INR. Monitor INR closely.
## Monitoring
* Renal and hepatic function (especially in patients with pre-existing impairment or on concurrent nephrotoxic agents).
* Complete blood count.
* Signs and symptoms of infection resolution.
* Prothrombin time/INR if patient is on anticoagulants or has risk factors for coagulopathy.
* Monitor for hypersensitivity reactions.
## Clinical Pearls
* Dosing frequency is every 24 hours, simplifying administration for many outpatient and inpatient regimens.
* Can be administered intramuscularly without dilution. Intravenous administration can be given as a bolus or over 30 minutes.
* The long half-life allows for once-daily dosing.
* Effective for empiric treatment of meningitis pending culture results.
* Consider its use in penicillin-allergic patients; however, cross-reactivity can occur in those with severe penicillin allergy.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and relevant guidelines before making any clinical decisions.
