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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
* Bacterial meningitis
* Hospital-acquired pneumonia
* Uncomplicated gonorrhea
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams (g) every 12 to 24 hours.
* **Severe Infections:** Doses up to 4 grams (g) daily may be administered in divided doses every 12 hours.
* **Uncomplicated Gonorrhea:** 500 milligrams (mg) intramuscularly (IM) as a single dose. For disseminated gonococcal infections, consult specific guidelines.
* **Surgical Prophylaxis:** 1 to 2 grams (g) IV within 60 minutes prior to incision.
## Pediatric Dosing
* **Meningitis:** 100 mg/kg/day IV divided every 12 to 24 hours. Maximum 4 grams (g) daily.
* **Other Infections:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours. Maximum 2 grams (g) daily for infants and children, or 4 grams (g) daily for adolescents.
## Dose Adjustments
No dose adjustment is necessary for renal impairment due to significant biliary excretion.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 28 days of age) receiving IV calcium-containing solutions.
## Adverse Effects
* Phlebitis (with IV administration)
* Eosinophilia, leukopenia, thrombocytopenia
* Rash, pruritus
* Diarrhea, nausea, vomiting
* Increased liver enzymes
* Biliary sludge/cholelithiasis (especially in children)
* Jarisch-Herxheimer reaction (with treatment of syphilis)
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Oral Contraceptives:** May decrease efficacy.
* **Probenecid:** Can increase ceftriaxone levels.
* **Calcium-containing solutions/products (IV):** Contraindicated in neonates. Risk of precipitates in IV lines.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count.
* Electrolytes if receiving prolonged therapy.
* Monitor for hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone can cause biliary pseudolithiasis, particularly in pediatric patients. This is usually transient and asymptomatic.
* Ensure adequate hydration to minimize the risk of crystalluria.
* Discontinue and switch to an alternative agent if a serious hypersensitivity reaction occurs.
* For IM administration, lidocaine may be used as a diluent for reconstituting the powder to reduce injection site pain; however, ensure the lidocaine concentration is appropriate and consider contraindications.
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*Disclaimer: This information is intended for clinical professionals. Always consult the most current prescribing information and institutional guidelines before making treatment decisions.*
