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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Pneumonia
* Meningitis
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Sepsis
* Gonorrhea
## Adult Dosing
* **General infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Complicated gonorrhea:** 1 gram IV or IM every 24 hours for 7 days.
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes prior to incision.
Maximum daily dose is typically 4 grams.
## Pediatric Dosing
Dosing is weight-based and depends on the indication and severity of infection. Consult specific pediatric guidelines.
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours.
* **Neonates (15-28 days):** 25-50 mg/kg IV every 12-24 hours.
* **Infants and Children (>28 days):** 50-100 mg/kg/day IV or IM in 1-2 divided doses.
* **Meningitis (infants and children):** 100 mg/kg/day IV in 2 divided doses.
Maximum daily dose is 2 grams for neonates and 4 grams for older children.
## Dose Adjustments
No dose adjustment is generally required for renal impairment, as ceftriaxone is largely cleared by hepatic metabolism. However, in severe hepatic or renal dysfunction, consideration may be given to reducing the dose.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving calcium-containing solutions or infusions, especially premature neonates, due to the risk of precipitation.
## Adverse Effects
* Diarrhea
* Nausea
* Vomiting
* Rash
* Eosinophilia
* Thrombocytosis
* Phlebitis at the injection site
* Biliary sludging (more common in pediatrics)
* Renal and hepatic enzyme elevations
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together, especially in renal impairment.
* **Warfarin:** Ceftriaxone may decrease the efficacy of warfarin; monitor INR closely.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* Signs and symptoms of infection (fever, WBC count, inflammatory markers).
* Renal and hepatic function.
* Injection site for signs of phlebitis.
* Electrolytes, especially in neonates.
## Clinical Pearls
* Ceftriaxone can be reconstituted with lidocaine for IM injection to reduce pain; *do not administer IV with lidocaine*.
* Avoid concurrent use with calcium-containing solutions in all patients, especially neonates.
* Biliary sludging can occur and is usually transient and asymptomatic.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always consult the most current prescribing information and institutional protocols before administering any medication.
