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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
* Pneumonia (community-acquired, hospital-acquired)
* Bacterial meningitis
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Gonococcal infections
* Perioperative prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams IV/IM every 24 hours.
* **Severe infections:** Doses up to 4 grams IV daily in 2 equally divided doses (e.g., 2 grams IV every 12 hours).
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM in a single dose.
* **Perioperative prophylaxis:** 1 to 2 grams IV/IM 30 to 60 minutes before surgical incision.
Maximum dose: 4 grams IV daily.
## Pediatric Dosing
* **General infections:** 50 to 100 mg/kg/day IV/IM in divided doses every 12 to 24 hours.
* **Severe infections:** Up to 150 mg/kg/day IV/IM in divided doses every 8 to 12 hours.
* **Meningitis:** 100 mg/kg/day IV in divided doses every 12 hours.
* **Neonates (<7 days):** Maximum 50 mg/kg/day IV/IM in a single daily dose.
* **Neonates (7 to 14 days):** Maximum 100 mg/kg/day IV/IM in divided doses every 12 hours.
Maximum dose: 4 grams IV daily. Dosing for neonates requires careful consideration due to potential for bilirubin displacement.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment. However, monitor closely in severe impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (less than 28 days old) receiving IV calcium-containing solutions, including continuous IV infusions of parenteral nutrition.
## Adverse Effects
* **Common:** Diarrhea, rash, injection site reactions (pain, phlebitis).
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge/lithiasis, eosinophilia, thrombocytopenia, leukopenia, hemolytic anemia, kernicterus (in neonates).
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity, especially with concurrent use for severe infections.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR.
* **Calcium-containing solutions:** Contraindicated in neonates (risk of precipitation).
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count (CBC) with differential and platelet count.
* Bilirubin levels in neonates.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in adults if preferred, but lidocaine is often used for added comfort.
* Biliary sludge formation is common and usually asymptomatic. Discontinuation is typically not required unless symptomatic.
* Ensure adequate hydration to minimize the risk of crystalluria.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before making clinical decisions.*
