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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
* Lower respiratory tract infections (e.g., pneumonia)
* Meningitis (bacterial)
* Bone and joint infections
* Complicated skin and soft tissue infections
* Uncomplicated skin and soft tissue infections
* Urinary tract infections (complicated)
* Pelvic inflammatory disease
* Bacterial septicemia
* Surgical prophylaxis
* Gonorrhea
## Adult Dosing
* **General infections:** 1 to 2 grams (g) intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections:** Doses may be increased to 4 g IV every 24 hours, divided into two doses (2 g every 12 hours).
* **Surgical prophylaxis:** 1 to 2 g IV 30-60 minutes before surgery.
* **Gonorrhea:** 250 mg IM as a single dose.
* **Meningitis:** 2 g IV every 12 hours.
## Pediatric Dosing
Dosing varies significantly by indication and patient weight. Consult specific pediatric infectious disease guidelines or institutional protocols. General guidelines:
* **Serious infections:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours.
* **Meningitis:** 80 to 100 mg/kg/day IV divided every 12 to 24 hours.
* **Neonates (0-14 days):** Maximum dose of 50 mg/kg/day IV divided every 24 hours.
* **Neonates (15-28 days):** Maximum dose of 80 mg/kg/day IV divided every 12 to 24 hours.
* **Children > 12 years:** Same as adult doses.
## Dose Adjustments
No dose adjustment is necessary in patients with impaired renal or hepatic function, as ceftriaxone is primarily cleared by hepatic metabolism and biliary excretion. However, in severe hepatic impairment, monitoring may be considered.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (less than 28 days old) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at the injection site, eosinophilia, thrombocytosis.
* **Serious:** Clostridium difficile-associated diarrhea, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, biliary sludge or gallstones, renal impairment, leukopenia, hemolytic anemia.
## Key Drug Interactions
* **Calcium-containing solutions (IV):** Risk of life-threatening precipitation in the lungs and kidneys, especially in neonates. Avoid concurrent administration. If incompatible, flush lines thoroughly between administrations.
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may potentiate the effect of warfarin. Monitor INR.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea, especially if severe or persistent, to assess for C. difficile infection.
* Monitor liver function tests (LFTs) and renal function tests (RFTs) periodically, especially with prolonged therapy.
* Monitor for signs of phlebitis at the IV insertion site.
* Monitor INR if patient is on warfarin.
## Clinical Pearls
* Ceftriaxone is a long-acting cephalosporin, allowing for once-daily dosing for many indications.
* Intramuscular administration is less painful with lidocaine as the diluent.
* Dosing for specific indications like meningitis and gonorrhea should follow established guidelines.
* Biliary sludge formation is common, usually asymptomatic, and resolves after discontinuation. However, symptomatic cases may require intervention.
* Ceftriaxone is effective for disseminated gonococcal infections and Lyme disease.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making any clinical decisions.
