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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
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Bacterial meningitis (in combination with other agents for certain pathogens)
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Skin and skin structure infections
* Complicated urinary tract infections and pyelonephritis
* Sepsis
* Preoperative surgical prophylaxis
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 12-24 hours.
* **Serious infections:** Up to 4 grams IV every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes before surgery.
## Pediatric Dosing
* **Neonates (< 7 days):** 25-50 mg/kg IV/IM every 24 hours. **Do not exceed 50 mg/kg/day.** Do not co-administer with calcium-containing solutions in neonates.
* **Infants and Children (> 7 days to 12 years, < 50 kg):**
* **General infections:** 50-100 mg/kg/day IV/IM in 1-2 divided doses.
* **Serious infections:** Up to 100 mg/kg/day IV/IM. **Maximum 2 grams/day.**
* **Meningitis:** 100 mg/kg/day IV in 2 divided doses. **Maximum 4 grams/day.**
* **Children > 12 years (or > 50 kg):** Use adult dosing.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment. However, caution and close monitoring are advised in severe impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Concomitant use with calcium-containing solutions in neonates (risk of precipitation).
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis, eosinophilia, thrombocytosis.
* **Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, Stevens-Johnson syndrome, hepatic dysfunction, cholelithiasis, biliary sludge, neutropenia, hemolytic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together, particularly in severe infections or renal impairment.
* **Warfarin:** Ceftriaxone may affect the INR. Monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone serum levels.
* **Calcium-containing solutions/products:** Contraindicated in neonates due to risk of fatal precipitation in lungs and kidneys.
## Monitoring
* Assess for signs and symptoms of allergic reaction.
* Monitor for development of *C. difficile*-associated diarrhea.
* Monitor blood counts, liver function tests, and renal function, especially with prolonged therapy.
* Monitor for clinical signs of infection resolution.
## Clinical Pearls
* Ceftriaxone is often a first-line agent for empiric treatment of serious infections, including meningitis and community-acquired pneumonia.
* Dosing for meningitis and other severe infections in pediatrics can be high and requires careful calculation.
* Reconstitute and dilute according to manufacturer's instructions. IV administration should be over 30 minutes or given as a continuous infusion. IM injections are painful and should be administered deeply. Lidocaine may be used as a diluent for IM injections.
* Ensure adequate hydration.
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*Please verify current prescribing information with the manufacturer's official product monograph or a trusted drug information resource before use.*
