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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 organisms. It is administered intravenously or intramuscularly.
## Primary Indications
* **Community-acquired pneumonia (CAP)**
* **Hospital-acquired pneumonia (HAP)**
* **Uncomplicated and complicated skin and skin structure infections (SSSI)**
* **Urinary tract infections (UTIs), including pyelonephritis**
* **Bacterial meningitis**
* **Sepsis**
* **Pelvic inflammatory disease (PID)**
* **Prophylaxis for surgical site infections**
## Adult Dosing
* **General infections:** 1 to 2 grams intravenously or intramuscularly every 24 hours.
* **Severe infections:** Up to 4 grams intravenously every 24 hours, usually divided into two doses (e.g., 2 grams every 12 hours).
* **Surgical prophylaxis:** 1 to 2 grams intravenously or intramuscularly given 30 to 120 minutes prior to incision.
* **Meningitis:** 2 grams intravenously every 12 hours.
Dosing for specific indications like gonorrhea (e.g., uncomplicated disseminated gonococcal infection) may differ and should be guided by local protocols and current guidelines.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg intravenously every 24 hours. Maximum 50 mg/kg/day. Avoid concomitant IV calcium-containing solutions.
* **Neonates (15-28 days):** 50 mg/kg intravenously every 24 hours. Maximum 2 grams/day. Avoid concomitant IV calcium-containing solutions.
* **Children (> 28 days up to 12 years):**
* **General infections:** 50-100 mg/kg intravenously or intramuscularly every 24 hours. Maximum 2 grams/day.
* **Severe infections/Meningitis:** 80-100 mg/kg intravenously every 24 hours, typically divided every 12 hours. Maximum 4 grams/day.
Dosing for pediatric meningitis often follows specific protocols.
## Dose Adjustments
* **Renal impairment:** No dose adjustment is generally required due to high biliary excretion. However, in patients with severe renal impairment (CrCl < 10 mL/min) and without concomitant hepatic dysfunction, the total daily dose should not exceed 2 grams.
* **Hepatic impairment:** No dose adjustment is generally required. In patients with both severe renal and hepatic impairment, monitor ceftriaxone levels and adjust dose if necessary; total daily dose should not exceed 2 grams.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or any component of the formulation.
* Neonates (less than or equal to 41 weeks post-conception) receiving IV calcium-containing solutions, including continuous IV infusions of parenteral nutrition.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site.
* **Less Common:** Eosinophilia, thrombocytosis, leukopenia, abdominal pain, headache, dizziness, candidiasis.
* **Rare/Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), biliary sludging (especially in neonates, leading to pseudolithiasis), anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, pancreatitis, renal failure, hepatic dysfunction, seizures.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity and ototoxicity, especially in patients with impaired renal function.
* **Probenecid:** May increase and prolong ceftriaxone plasma levels.
* **Warfarin:** Ceftriaxone may inhibit vitamin K synthesis, potentially enhancing the effect of warfarin. Monitor INR.
* **Calcium-containing solutions/products:** Risk of fatal precipitation in neonates. Do not mix or administer ceftriaxone simultaneously with calcium-containing solutions or products, even by different infusion lines or at different sites.
## Monitoring
* **Signs and symptoms of infection:** Monitor for improvement in fever, pain, and other clinical signs.
* **Renal and hepatic function:** Monitor baseline and periodically, especially in patients with impaired function or receiving prolonged therapy.
* **Complete blood count (CBC):** Monitor for potential hematologic effects.
* **Signs of hypersensitivity reactions:** Monitor closely during and after administration.
* **Biliary assessment:** Consider monitoring for biliary sludge in prolonged therapy or in neonates.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in most adult and pediatric patients.
* It is often the drug of choice for empirical treatment of meningitis and serious infections like sepsis.
* When reconstituting ceftriaxone for IV use, use sterile water for injection, D5W, or NS. For IM use, use sterile water for injection or 1% lidocaine. Reconstituted solutions are stable for specified times depending on the diluent and storage conditions.
* Never use lidocaine as a diluent for IV administration.
* Ceftriaxone is not adequately removed by hemodialysis.
This information is a summary and does not replace a thorough review of the most current prescribing information or consultation with a pharmacist or physician. Always verify current prescribing information before use.
