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## Cefriaxone
### 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
* Pneumonia (community-acquired and hospital-acquired)
* Bacterial meningitis
* Sepsis
* Urinary tract infections
* Skin and soft tissue infections
* Bone and joint infections
* Gonococcal infections (including disseminated gonorrhea and pelvic inflammatory disease)
* Prophylaxis for surgical site infections
### Adult Dosing
* **General infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours, divided into two doses (2 grams every 12 hours).
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Complicated gonorrhea/Pelvic inflammatory disease:** 1 gram IV or IM every 24 hours for 10-14 days.
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
Dosing for specific indications may vary based on severity and local antimicrobial susceptibility patterns.
### Pediatric Dosing
* **Neonate (< 7 days):** 25-50 mg/kg IV every 24 hours.
* **Neonate (> 7 days, < 2kg):** 25-50 mg/kg IV every 24 hours.
* **Neonate (> 7 days, ≥ 2kg):** 50-75 mg/kg IV every 24 hours.
* **Infants and Children (> 28 days):**
* **General infections:** 50-100 mg/kg/day IV or IM, divided into two doses (every 12 hours).
* **Severe infections:** Up to 150 mg/kg/day IV or IM, divided into two doses (maximum 4 grams/day).
* **Meningitis:** 100 mg/kg/day IV, divided into two doses (every 12 hours), for a total of 7-21 days.
### Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally required in adults or children with renal impairment, as ceftriaxone is primarily eliminated by the liver. However, caution and monitoring may be advised in severe renal dysfunction.
* **Hepatic Impairment:** No dose adjustment is generally required.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (especially premature) receiving IV calcium-containing solutions due to risk of ceftriaxone-calcium precipitates.
### Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, phlebitis at the injection site, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludge/pseudolithiasis (especially in neonates), severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, hemolytic anemia, aplastic anemia, pancreatitis.
### Key Drug Interactions
* **Calcium-containing IV solutions:** Contraindicated in neonates due to risk of precipitation. In adults, though less common, co-administration should be done cautiously and the lines flushed between infusions.
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** May decrease the effect of warfarin, leading to increased INR. Monitor INR closely.
### Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count.
* Signs of hypersensitivity reactions.
* Signs of *C. difficile* infection (diarrhea).
* Biliary symptoms (abdominal pain, jaundice).
### Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in adults and older children.
* Once-daily dosing simplifies administration.
* It has good penetration into cerebrospinal fluid, making it a preferred agent for bacterial meningitis.
* Be aware of the risk of biliary pseudolithiasis, particularly in neonates and prolonged therapy.
This information is intended as a quick reference. Always consult the most current prescribing information and local institutional protocols before administering ceftriaxone.
