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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
* Serious infections caused by susceptible organisms, including:
* Bacterial meningitis
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Skin and soft tissue infections
* Urinary tract infections (including pyelonephritis)
* Pelvic inflammatory disease
* Bacterial sepsis
* Chancroid
* Disseminated gonococcal infections
* Lyme disease (especially neuroborreliosis and carditis)
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams IV/IM every 12 or 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonococcal Infections:** 250 mg IM as a single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV/IM every 24 hours for 7 days.
* **Chancroid:** 500 mg IM as a single dose.
* **Lyme Disease (Neuroborreliosis/Carditis):** 2 grams IV every 24 hours for 14-30 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV/IM 30-60 minutes before surgery.
* **Maximum Dose:** 4 grams per day for severe infections.
## Pediatric Dosing
Dosing is weight-based and depends on the indication and severity of infection. Specific protocols should be consulted.
* **General Infections:** 50 to 100 mg/kg/day IV/IM divided every 12 or 24 hours.
* **Meningitis:** 80 to 100 mg/kg/day IV divided every 12 or 24 hours.
* **Neonates (0-14 days):** Maximum 50 mg/kg/day IV divided every 24 hours due to risk of kernicterus.
* **Neonates (15-28 days):** Maximum 75 mg/kg/day IV divided every 12 or 24 hours.
* **Maximum Pediatric Dose:** Generally 2 grams per day, but up to 4 grams per day may be used in severe infections under specific guidance.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed in adults or children with impaired renal function unless severe hepatic dysfunction is also present. Ceftriaxone is significantly cleared by the liver.
* **Hepatic Impairment:** No dose adjustment is typically needed in adults or children with impaired hepatic function unless severe renal impairment is also present.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 28 days old) receiving IV calcium-containing solutions or infusions due to risk of ceftriaxone-calcium precipitates.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis (at injection site), pain/induration (at IM site), eosinophilia, elevated liver enzymes.
* **Serious:**
* Severe hypersensitivity reactions (anaphylaxis).
* Clostridioides difficile-associated diarrhea (CDAD).
* Biliary sludge/cholecystitis (especially in children and with prolonged therapy).
* Hemolytic anemia (rare).
* Acute renal failure (rare).
* Pseudolithiasis (lung and urinary tract).
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together, particularly in severe infections or with renal impairment.
* **Probenecid:** Can increase and prolong ceftriaxone levels.
* **Oral Contraceptives:** May decrease efficacy.
* **Calcium-containing Solutions:** Contraindicated in neonates receiving IV ceftriaxone.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea and signs of C. difficile infection.
* Monitor liver function tests and renal function.
* Consider monitoring for biliary sludge, especially in infants and with prolonged therapy.
* Monitor culture and sensitivity results for treatment efficacy.
## Clinical Pearls
* Ceftriaxone is often a choice for empiric therapy due to its broad spectrum.
* The long half-life allows for once or twice daily dosing.
* Can be reconstituted with lidocaine for IM injection to reduce pain, but **never use lidocaine for IV administration.**
* Avoid concurrent administration with calcium-containing solutions in all patients, especially neonates. Separate IV lines and flush adequately.
* Significant binding to plasma proteins can affect some laboratory tests (e.g., PT/INR).
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
