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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 via intravenous (IV) or intramuscular (IM) injection.
## Primary Indications
* Bacterial meningitis
* Pneumonia (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Bone and joint infections
* Intra-abdominal infections
* Sepsis
* Gonorrhea and syphilis
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 12-24 hours. Doses up to 4 grams daily have been used for severe infections.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM single dose.
* **Disseminated gonococcal infection:** 1 gram IV every 24 hours for 7 days.
* **Syphilis (secondary/tertiary):** 2-3 grams IV/IM every 24 hours for 10-14 days.
* **Surgical prophylaxis:** 1-2 grams IV within 60 minutes prior to incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV/IM every 24 hours. **Do not exceed 50 mg/kg/day.** Avoid concomitant IV calcium administration.
* **Neonates (15-28 days):** 25-50 mg/kg IV/IM every 12-24 hours. **Do not exceed 50 mg/kg/day.**
* **Infants and Children (>28 days):** 50-100 mg/kg/day IV/IM divided every 12-24 hours. For severe infections, doses up to 150 mg/kg/day divided every 8-12 hours may be used. **Maximum daily dose for children is 4 grams.**
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically necessary due to extensive hepatic and biliary excretion. However, in severe renal impairment, monitor clinical response.
* **Hepatic Impairment:** No dose adjustment is typically necessary. In severe hepatic impairment with concomitant renal impairment, monitor clinical response.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (term and preterm) receiving IV calcium-containing solutions or infusions due to risk of precipitate formation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis, pain/induration at injection site.
* **Serious:** Clostridium difficile-associated diarrhea, hypersensitivity reactions (anaphylaxis), biliary sludging/cholelithiasis (especially in neonates and with prolonged therapy), leukopenia, thrombocytopenia, hemolytic anemia, renal impairment.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity and ototoxicity, especially in severe renal impairment.
* **Warfarin:** Ceftriaxone may alter the response to warfarin; monitor INR closely.
* **Oral Contraceptives:** Ceftriaxone may reduce the efficacy of oral contraceptives.
* **Calcium-containing solutions (IV):** **Contraindicated in neonates.** In adults and children, avoid co-administration through the same IV line due to risk of precipitate formation in the lungs and kidneys. If co-administration is necessary, flush lines thoroughly.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function tests (especially with prolonged therapy or in patients with pre-existing impairment).
* Complete blood count.
* Prothrombin time (especially in patients on warfarin or with impaired hepatic function).
* Monitor for adverse effects, including diarrhea and signs of hypersensitivity.
## Clinical Pearls
* Ceftriaxone is often a preferred agent for empiric treatment of community-acquired pneumonia and meningitis in outpatient settings due to its long half-life allowing for once or twice-daily dosing.
* The risk of biliary sludging is increased with higher doses and longer duration of therapy. It is generally asymptomatic and resolves after discontinuation.
* When reconstituting, ensure proper technique to avoid particulate matter.
* For IM administration, dilute with lidocaine hydrochloride 1% (without epinephrine) to reduce injection pain.
**Disclaimer:** This information is for clinical use and does not replace the official prescribing information. Always consult the most current drug monograph and institutional protocols for complete details.
