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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 parenterally.
## Primary Indications
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Acute bacterial meningitis (except in neonates)
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Bacterial sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Prophylaxis for surgical site infections
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 12-24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours.
* **Uncomplicated gonorrhea:** 500 mg IM single dose.
* **Complicated gonorrhea:** 1 gram IM single dose.
* **Surgical prophylaxis:** 1-2 grams IV single dose, 30-60 minutes prior to incision.
Dosing for meningitis and other severe infections may require specific protocols; consult local guidelines.
## Pediatric Dosing
* **Neonates (< 28 days):** 25-50 mg/kg IV/IM every 24 hours. *Note: Do not exceed 50 mg/kg/day due to risk of kernicterus. Avoid IV in neonates with hyperbilirubinemia.*
* **Infants and Children (> 28 days):**
* **Uncomplicated infections:** 50-75 mg/kg IV/IM every 24 hours (maximum 2 grams/day).
* **Severe infections (e.g., meningitis):** 80-100 mg/kg IV/IM every 24 hours, divided every 12 hours (maximum 4 grams/day).
## Dose Adjustments
No dose adjustment is necessary in adult patients with renal or hepatic impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving IV calcium-containing solutions concurrently or within 48 hours.
## Adverse Effects
* Diarrhea
* Nausea, vomiting
* Rash, pruritus
* Eosinophilia
* Thrombocytosis
* Local injection site reactions (pain, phlebitis)
* Biliary sludge/cholelithiasis (especially in children)
* Rare: anaphylaxis, Clostridioides difficile-associated diarrhea.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, though synergistic for some infections. Monitor renal function.
* **Warfarin:** May alter INR. Monitor INR closely and adjust warfarin dose as needed.
* **Probenecid:** May increase and prolong ceftriaxone levels.
## Monitoring
* Signs and symptoms of infection resolution.
* Renal and hepatic function, particularly in patients with pre-existing impairment or receiving other nephrotoxic/hepatotoxic agents.
* For prolonged therapy: CBC, liver function tests, signs of biliary sludge.
## Clinical Pearls
* Ceftriaxone is often the preferred agent for empiric treatment of community-acquired pneumonia and meningitis in many settings.
* Avoid reconstitution and administration with lidocaine in neonates.
* When treating gonorrhea, partner notification and treatment are essential.
* Biliary sludging is a common, usually asymptomatic, finding in children treated with ceftriaxone and typically resolves after discontinuation.
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*Please verify current prescribing information and consult with a healthcare professional for specific patient management decisions.*
