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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. It is administered intravenously or intramuscularly.
## Primary Indications
* **Bacterial meningitis:** Especially in community-acquired meningitis.
* **Pneumonia:** Community-acquired and hospital-acquired pneumonia.
* **Skin and soft tissue infections:** Complicated and uncomplicated.
* **Urinary tract infections:** Including pyelonephritis and complicated UTIs.
* **Biliary tract infections and cholecystitis.**
* **Intra-abdominal infections.**
* **Gonorrhea:** Uncomplicated urogenital, rectal, and pharyngeal gonorrhea.
* **Sepsis.**
* **Surgical prophylaxis.**
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Severe Infections:** Doses up to 4 grams IV per day have been used, typically divided every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose. For disseminated gonococcal infection, 1 gram IV or IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
Dosing for pediatric patients depends on age, weight, and indication, and requires careful calculation. Dosing is often guided by local institutional protocols.
* **General Infections (Neonate < 7 days):** 25-50 mg/kg IV or IM every 24 hours.
* **General Infections (Neonate > 7 days, <1500g):** 25 mg/kg IV or IM every 24 hours.
* **General Infections (Neonate > 7 days, >1500g):** 50 mg/kg IV or IM every 24 hours.
* **General Infections (Infants and Children):** 50-100 mg/kg IV or IM per day, divided every 12-24 hours. Maximum daily dose is typically 2 grams.
* **Meningitis (Infants and Children):** 100 mg/kg IV per day, divided every 12 or 24 hours. Maximum daily dose is typically 4 grams.
## Dose Adjustments
No dose adjustment is generally required for renal impairment. Ceftriaxone is primarily eliminated by hepatic metabolism and biliary excretion. In severe hepatic insufficiency, monitoring may be considered.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving concomitant calcium-containing IV solutions or products due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis (with IV administration), eosinophilia, thrombocytosis.
* **Serious:** Severe hypersensitivity reactions (anaphylaxis), Clostridioides difficile-associated diarrhea, biliary sludge or pseudolithiasis (especially in neonates), Stevens-Johnson syndrome, toxic epidermal necrolysis, hemolytic anemia, renal injury, neurological effects (seizures).
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity and ototoxicity, particularly in patients with renal impairment.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin, requiring increased monitoring of INR.
* **Probenecid:** May increase ceftriaxone serum concentrations.
* **Calcium-containing IV solutions:** Contraindicated in neonates due to risk of fatal precipitation in the lungs and kidneys.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for effectiveness of treatment (e.g., fever reduction, improvement in clinical signs).
* Monitor for adverse effects such as diarrhea and rash.
* In neonates, monitor for signs of biliary precipitation.
## Clinical Pearls
* Ceftriaxone is often used for empirical treatment of serious infections due to its broad spectrum.
* It can be given IM without dilution, which is convenient for outpatient parenteral antimicrobial therapy (OPAT).
* Due to its long half-life, it can be dosed once daily for many indications.
* Ceftriaxone is a common treatment for community-acquired pneumonia and meningitis.
* When used for gonorrhea, partner notification and treatment are essential.
* The risk of biliary pseudolithiasis is highest in neonates and pediatric patients receiving prolonged or high-dose therapy.
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*Disclaimer: This information is intended for healthcare professionals and should not be used as a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.*
