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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
* **Serious bacterial infections:** Including pneumonia, meningitis, bone and joint infections, intra-abdominal infections, skin and soft tissue infections, urinary tract infections, and gonorrhea.
* **Surgical prophylaxis.**
## Adult Dosing
* **General:** 1 to 2 grams intravenously or intramuscularly every 12 or 24 hours.
* **Serious infections:** Up to 4 grams intravenously every 24 hours.
* **Uncomplicated gonorrhea:** 500 mg intramuscularly as a single dose.
* **Disseminated gonococcal infections:** 1 gram intravenously or intramuscularly every 24 hours for 7 days.
* **Surgical prophylaxis:** 1 to 2 grams intravenously 30 to 120 minutes before surgery.
Dosing frequency and duration depend on the type and severity of infection, pathogen susceptibility, and patient response. Local protocols often guide specific dosing for certain infections.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg intravenously or intramuscularly every 24 hours. Maximum 50 mg/kg/day.
* **Neonates (15-28 days) and pediatric patients > 28 days:**
* **General:** 50-100 mg/kg/day intravenously or intramuscularly in divided doses every 12 or 24 hours. Maximum 2 grams/day.
* **Serious infections:** Up to 100 mg/kg/day intravenously in divided doses every 12 or 24 hours. Maximum 4 grams/day.
* **Meningitis:** 100 mg/kg/day intravenously in divided doses every 12 or 24 hours. Maximum 4 grams/day. Duration of treatment should be considered for the specific organism.
* **Uncomplicated gonorrhea:** 125 mg intramuscularly as a single dose.
## Dose Adjustments
No dose adjustment is typically required in patients with renal impairment. Ceftriaxone is extensively cleared by the liver and kidneys. In severe hepatic impairment with concurrent renal impairment, caution may be advised, though specific dose adjustments are not usually mandated.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates (especially premature) receiving intravenous calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, elevated liver enzymes.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (anaphylaxis), biliary sludging or gallstones (especially in children), hemolytic anemia, neutropenia, renal impairment.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity and ototoxicity when used together, especially in patients with impaired renal function. Monitor levels and renal function.
* **Warfarin:** Ceftriaxone may decrease the effectiveness of warfarin. Monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions/infusions:** Contraindicated in neonates due to risk of precipitation in lungs and kidneys.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (baseline and periodically, especially with prolonged therapy or in patients with pre-existing impairment).
* Complete blood count.
* Bilirubin levels in neonates.
* Coagulation parameters if co-administered with warfarin.
## Clinical Pearls
* Ceftriaxone is often a first-line agent for many serious bacterial infections due to its broad spectrum and favorable pharmacokinetic profile (long half-life allowing once or twice daily dosing).
* For intramuscular administration, reconstitute with sterile water for injection or 1% lidocaine HCl without epinephrine.
* For intravenous administration, reconstitute with sterile water for injection, D5W, or NS. Infuse slowly over 30 minutes.
* In neonates, avoid concomitant use with calcium-containing IV fluids due to risk of fatal precipitation. Separate administration by at least 48 hours if both are necessary.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the current prescribing information and institutional protocols for complete and up-to-date guidance.*
