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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 bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Community-acquired pneumonia
* Bacterial meningitis (documented or suspected)
* Uncomplicated gonorrhea
* Sepsis
* Skin and skin structure infections
* Urinary tract infections (complicated and uncomplicated)
* Intra-abdominal infections
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams IV or IM every 12 or 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
* **Uncomplicated Gonorrhea:** 250 mg IM single dose.
Dosing frequency and duration depend on the specific indication, severity of infection, and clinical response.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV or IM every 24 hours. Avoid IV use with hyperbilirubinemia. Maximum 50 mg/kg/day.
* **Neonates (15-28 days):** 25-50 mg/kg IV or IM every 24 hours. If jaundiced, use 25 mg/kg/day.
* **Pediatric Patients (>28 days to 12 years):**
* **General Infections:** 50-100 mg/kg/day IV or IM divided every 12-24 hours.
* **Severe Infections:** Up to 120 mg/kg/day (maximum 4 grams/day) IV divided every 12-24 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
* **Adolescents (>12 years):** Dosing typically follows adult guidelines.
## Dose Adjustments
No dose adjustment is generally needed for renal impairment. However, it is generally not removed by hemodialysis.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates with hyperbilirubinemia, especially those requiring calcium therapy or in conditions where calcium might bind to ceftriaxone.
## Adverse Effects
* **Common:** Diarrhea, rash, injection site reactions (pain, phlebitis).
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludging, hemolytic anemia, interstitial nephritis, seizures.
## Key Drug Interactions
* **Aminoglycosides:** Increased nephrotoxicity risk.
* **Probenecid:** Can increase and prolong ceftriaxone plasma concentrations.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of precipitation. Use caution in adults.
## Monitoring
* Renal and hepatic function.
* Signs and symptoms of infection.
* For prolonged therapy: complete blood count.
* Monitor for adverse effects, particularly diarrhea and hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing.
* It is a preferred agent for empiric treatment of meningitis and community-acquired pneumonia.
* IM administration should be done with lidocaine to reduce pain.
* Do not mix or administer ceftriaxone simultaneously with calcium-containing IV products, except in specific situations (e.g., diluted infusions over time in non-neonates).
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*Please verify current prescribing information and institutional protocols before administering.*
