Please check your internet connection and try again.
# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria.
## Primary Indications
* Community-acquired pneumonia
* Skin and soft tissue infections
* Urinary tract infections
* Meningitis (bacterial)
* Sepsis
* Gonorrhea
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe Infections:** Up to 4 grams IV daily, divided every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30 to 60 minutes prior to incision.
## Pediatric Dosing
* **Neonate (0-14 days):** 25 to 50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonate (>14 days) and Children:** 50 to 100 mg/kg IV or IM every 12 to 24 hours.
* **Severe Infections (Children):** Up to 150 mg/kg/day IV or IM, divided every 8 to 12 hours. Maximum dose 8 grams daily.
* **Meningitis (Children):** 100 mg/kg IV every 12 hours.
*Note: Specific dosing for neonates and the duration of treatment often depend on institutional protocols and clinical judgment.*
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally required in adults with renal impairment, as ceftriaxone undergoes both renal and non-renal elimination. However, in severe renal impairment (CrCl < 10 mL/min), some guidelines suggest reducing the dose by 50% if the patient is not also receiving hemodialysis.
* **Hepatic Impairment:** No dose adjustment is typically required.
* **Concomitant Renal and Hepatic Impairment:** Dose reduction may be considered, especially in severe cases.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving IV calcium-containing solutions, including continuous parenteral nutrition, due to the risk of precipitation in pulmonary and renal vasculature.
## Adverse Effects
* **Common:** Diarrhea, rash, injection site reactions (pain, phlebitis).
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), hemolytic anemia, biliary sludge or cholelithiasis (especially in neonates), acute renal failure (rare).
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, particularly with high doses or prolonged therapy.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin, requiring increased monitoring of INR.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing Solutions:** Contraindicated in neonates (see Contraindications).
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for diarrhea and consider *C. difficile* testing if indicated.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing impairment.
* Monitor for signs of biliary sludge or cholelithiasis, particularly in neonates.
## Clinical Pearls
* Ceftriaxone is often a preferred agent for empiric treatment of serious bacterial infections due to its broad spectrum and favorable pharmacokinetic profile (long half-life allowing once or twice daily dosing).
* For IM administration, dilute with 1% lidocaine hydrochloride without epinephrine to reduce pain.
* Do not mix ceftriaxone with other cephalosporins.
* Ensure adequate hydration in patients receiving ceftriaxone to minimize the risk of crystalluria.
***
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete details before making any clinical decisions.
