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# Ceftriaxone
## Overview
Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic with good activity against many Gram-positive and Gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Skin and soft tissue infections
* Urinary tract infections
* Meningitis (bacterial)
* Sepsis
* Disseminated gonococcal infection
* Lyme disease (early and late stage)
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams (g) intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe Infections:** Up to 4 grams IV daily, divided every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Disseminated Gonococcal Infection:** 1 gram IM or IV once daily for 7 days.
* **Surgical Prophylaxis:** 1 to 2 g IV 30-60 minutes before incision.
Dosing may vary based on indication and severity; consult specific guidelines.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV or IM once daily. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days), Infants, and Children (<50 kg):** 50-100 mg/kg/day IV or IM divided every 12-24 hours. Maximum daily dose: 2 g.
* **Children (>50 kg):** Same as adult dosing.
* **Meningitis (Pediatric):** 80-100 mg/kg/day IV divided every 12 hours. Maximum daily dose: 4 g.
Dosing in neonates is complex due to immature hepatic and renal function. Specific protocols for neonates are crucial.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally necessary in adults with renal impairment due to extensive biliary excretion. In severe renal impairment with concomitant hepatic impairment, maximum dose should not exceed 2 g daily.
* **Hepatic Impairment:** No dose adjustment is generally necessary.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (≤ 41 weeks postmenstrual age) receiving IV calcium-containing solutions or infusions.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis at the injection site, pain/tenderness at the injection site, eosinophilia, thrombocytosis.
* **Serious:** Clostridioides difficile-associated diarrhea, Stevens-Johnson syndrome, anaphylaxis, biliary sludge/pseudolithiasis, hemolytic anemia, pancreatitis.
## Key Drug Interactions
* **Calcium-containing solutions/infusions (IV):** Contraindicated in neonates. In adults, although not absolutely contraindicated, coadministration should be avoided or given at separate administration sites with thorough flushing. Precipitate formation can occur in the lungs and kidneys.
* **Warfarin:** Ceftriaxone may decrease the efficacy of warfarin, leading to increased INR. Monitor INR closely.
* **Aminoglycosides:** Concurrent use may increase risk of nephrotoxicity, although evidence is limited.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile infection.
* Monitor infusion site for phlebitis or local reaction.
* Monitor renal and hepatic function periodically, especially in patients with pre-existing impairment or those receiving prolonged therapy.
* Monitor INR if co-administered with warfarin.
## Clinical Pearls
* Ceftriaxone is often given once daily for many infections due to its long half-life.
* IM administration is painful; consider lidocaine as a diluent if available and appropriate.
* For IV administration, reconstitute with appropriate sterile diluent (e.g., sterile water for injection, bacteriostatic water for injection).
* Ceftriaxone is a common choice for empiric treatment of meningitis and pneumonia.
* Avoid use in neonates receiving calcium-containing IV products.
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*This information is intended for healthcare professionals. Always verify current prescribing information, including contraindications, warnings, and drug interactions, with the official product labeling and other reliable resources before making clinical decisions.*
