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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Skin and skin structure infections
* Pneumonia
* Meningitis (including Neisseria meningitidis prophylaxis)
* Bacterial septicemia
* Urinary tract infections
* Pelvic inflammatory disease
* Complicated intra-abdominal infections
* Osteomyelitis
* Disseminated gonococcal infections
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams intravenously or intramuscularly every 12 to 24 hours.
* **Severe infections:** Up to 4 grams intravenously every 24 hours.
* **Meningitis:** 2 grams intravenously every 12 hours.
* **Surgical prophylaxis:** 1 to 2 grams intravenously or intramuscularly 30 to 60 minutes before incision.
## Pediatric Dosing
Dosing varies significantly by indication and age/weight. Consult specific pediatric guidelines.
* **General infections:** 50 to 100 mg/kg/day intravenously or intramuscularly divided every 12 to 24 hours. Maximum: 2 grams per day.
* **Severe infections:** Up to 100 mg/kg/day divided every 12 to 24 hours. Maximum: 4 grams per day.
* **Meningitis:** 100 mg/kg/day intravenously divided every 12 to 24 hours. Maximum: 4 grams per day.
* **Neonates (0-14 days):** 25 to 50 mg/kg/day intravenously divided every 24 hours.
* **Neonates (15-28 days):** 50 mg/kg/day intravenously divided every 12 to 24 hours.
* **Note:** In neonates, avoid concurrent IV administration with calcium-containing solutions due to risk of precipitation.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally needed for mild to moderate renal impairment. In severe renal impairment, consider reducing the dose by 50% if creatinine clearance is less than 10 mL/minute. However, many sources indicate no dose adjustment is necessary due to high biliary excretion.
* **Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates receiving calcium-containing intravenous fluids or calcium-containing products concurrently.
* Hyperbilirubinemic neonates.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, injection site reactions (pain, phlebitis).
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge/precipitation (especially in neonates and high doses), thrombocytopenia, eosinophilia, neutropenia, renal injury.
## Key Drug Interactions
* **Aminoglycosides:** May have additive nephrotoxicity.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Warfarin:** May alter INR; monitor closely.
* **Calcium-containing solutions/products (IV):** Contraindicated in neonates due to precipitation risk.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count (CBC) with differential.
* Signs of hypersensitivity reactions.
* For patients receiving warfarin, monitor INR.
* Monitor for diarrhea, especially if severe or persistent.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine for patients who are not allergic to lidocaine, but lidocaine is preferred for painful IM injections.
* Dosing frequency can often be extended to every 24 hours for many indications in adults due to its long half-life.
* Biliary pseudolithiasis (sludge) is a common, usually transient, and benign finding. Discontinuation is typically not necessary unless symptomatic.
* The maximum daily dose for adults is typically 4 grams.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information, institutional protocols, and patient-specific factors before making clinical decisions.*
