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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
* Community-acquired pneumonia
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Skin and soft tissue infections
* Urinary tract infections
* Sepsis
## Adult Dosing
* **General Infections:** 1 to 2 grams IV/IM every 12 to 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV/IM 30-60 minutes prior to incision.
**Maximum dose:** 4 grams per day.
## Pediatric Dosing
Dosing varies significantly by indication and age/weight. Refer to specific pediatric infectious disease guidelines or institutional protocols.
* **Meningitis (1 month to 12 years):** 100 mg/kg IV every 12 hours, not to exceed 2 grams every 12 hours.
* **Complicated UTI/Pyelonephritis (2 months to 12 years):** 50 to 75 mg/kg IV/IM once daily, not to exceed 2 grams per day.
## Dose Adjustments
No dose adjustment is typically needed in mild to moderate hepatic or renal impairment. In severe hepatic and renal impairment, the maximum dose should not exceed 2 grams daily.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 28 days old) receiving intravenous calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* Diarrhea
* Rash, pruritus
* Eosinophilia, leukopenia, thrombocytosis
* Increased liver enzymes
* Injection site pain/phlebitis
* Biliary sludge/cholelithiasis (more common in pediatrics)
* Pseudomembranous colitis
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates (see contraindications). Avoid concurrent administration with other IV medications containing calcium.
## Monitoring
* Renal and liver function
* Blood counts
* Signs and symptoms of infection
* Signs of hypersensitivity reactions
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine for reconstitution, but lidocaine is preferred for comfort.
* Dosing frequency can be extended to every 24 hours for many indications, particularly for less severe infections, due to its long half-life.
* Long-term therapy may require monitoring for biliary sludge formation.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines for complete and up-to-date details before making clinical decisions.*
