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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
* Skin and skin structure infections
* Pneumonia (community-acquired and hospital-acquired)
* Urinary tract infections
* Biliary tract infections and cholecystitis
* Bone and joint infections
* Meningitis
* Gonorrhea
* Perioperative prophylaxis
## Adult Dosing
* **General:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Maximum:** 4 grams per day.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infection, 1 gram IV or IM every 24 hours for 7 days.
* **Perioperative Prophylaxis:** 1 to 2 grams IV 30 to 120 minutes before incision.
Dosing for specific indications may vary based on severity and local protocols.
## Pediatric Dosing
* **General:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours.
* **Maximum:** 2 grams per day.
* **Meningitis:** 100 mg/kg/day IV divided every 12 to 24 hours, not to exceed 4 grams/day.
* **Neonates (<7 days):** 25 to 50 mg/kg/day IV or IM divided every 24 hours.
Dosing for specific pediatric indications may vary based on age, weight, and local protocols.
## Dose Adjustments
No dose adjustment is generally required for renal impairment. However, clearance can be reduced in severe hepatic impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (birth to 28 days) receiving concurrent IV calcium-containing solutions.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis, pain at injection site.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), biliary sludging, hematologic reactions (eosinophilia, leukopenia, thrombocytopenia), interstitial nephritis.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity.
* **Probenecid:** May increase ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates. Avoid coadministration in adults via the same IV line.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of *C. difficile*-associated diarrhea.
* Monitor CBC and renal function if prolonged therapy is anticipated.
* Monitor for biliary sludging, especially in children.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in adults, though lidocaine may be used to reduce injection site pain.
* Biliary sludging is a common, generally benign, but sometimes symptomatic side effect, particularly in pediatric patients.
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**Disclaimer:** This information is for clinical decision support only and does not replace comprehensive drug information resources or clinical judgment. Always consult the current prescribing information and relevant guidelines before making therapeutic decisions.
