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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative organisms. It is administered intravenously or intramuscularly.
## Primary Indications
* Bacterial meningitis
* Pneumonia
* Skin and soft tissue infections
* Urinary tract infections
* Sepsis
* Gonorrhea
* Surgical prophylaxis
## Adult Dosing
* **General:** 1-2 grams IV or IM every 12-24 hours.
* **Severe infections:** Up to 4 grams IV per day in divided doses every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM x 1 dose.
* **Disseminated gonococcal infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **Neonate (0-14 days):** 25-50 mg/kg IV or IM every 24 hours.
* **Neonate (>14 days) and Children:** 50-100 mg/kg IV or IM every 12-24 hours, not to exceed 2 grams per day.
* **Meningitis:** 100 mg/kg IV per day divided every 12 hours, not to exceed 4 grams per day. Dosing may depend on local guidelines and pathogen susceptibility.
## Dose Adjustments
No dose adjustment is typically necessary in patients with mild to moderate renal or hepatic impairment. In severe renal impairment (CrCl <10 mL/min), the maximum daily dose should not exceed 2 grams.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 28 days) receiving intravenous calcium-containing solutions or infusions due to risk of ceftriaxone-calcium precipitation.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, phlebitis.
Less Common: Eosinophilia, leukopenia, thrombocytopenia, elevated liver enzymes, abdominal pain.
Rare: Pseudomembranous colitis, anaphylaxis, biliary sludge, cholelithiasis, renal calcifications.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with prolonged use or high doses.
* **Warfarin:** May alter the effect of warfarin; monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions (IV):** Contraindicated in neonates due to risk of fatal precipitation in lungs and kidneys.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count.
* Biliary sludge/cholelithiasis with prolonged therapy.
## Clinical Pearls
* Ceftriaxone can be administered intramuscularly without lidocaine in neonates and infants, but lidocaine is often used for adult IM injections to reduce pain.
* Due to its long half-life, once-daily dosing is often possible.
* Ceftriaxone is highly protein-bound and can displace bilirubin from albumin, posing a risk of kernicterus in neonates; it is contraindicated in hyperbilirubinemic neonates requiring exchange transfusion or when sulfonamides are given.
* When mixing ceftriaxone, ensure compatibility with the diluent and avoid using calcium-containing diluents.
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*Please verify current prescribing information and institutional protocols before administration.*
