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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)
* Meningitis (bacterial)
* Sepsis
* Urinary tract infections (complicated)
* Skin and soft tissue infections
* Bone and joint infections
* Gonorrhea
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams IV/IM every 12 to 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1 to 2 grams IV/IM 30-60 minutes prior to incision.
* **Maximum Dose:** 4 grams per day.
## Pediatric Dosing
* **Neonate (0-14 days):** 25 to 50 mg/kg IV/IM once daily. Maximum 50 mg/kg/day.
* **Infants and Children (15 days to 12 years):** 50 to 100 mg/kg IV/IM once daily or in equally divided doses every 12 hours. Maximum 2 grams per day.
* **Adolescents (>12 years):** Dosing as per adult recommendations.
* **Meningitis:** 100 mg/kg IV once daily or in equally divided doses every 12 hours. Maximum 4 grams per day.
Note: Specific pediatric dosing may vary based on indication and local protocols. Doses exceeding 50 mg/kg in neonates should be given by IV infusion over 60 minutes to reduce the risk of bilirubin encephalopathy.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment generally required when used alone. If concomitant hepatic impairment, monitor levels.
* **Hepatic Impairment:** No dose adjustment generally required when used alone. If concomitant renal impairment, monitor levels.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 41 weeks postmenstrual age) receiving intravenous calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
Common: Diarrhea, rash, phlebitis at injection site, eosinophilia, thrombocytosis.
Serious: Clostridium difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), biliary sludging/cholelithiasis, hemolytic anemia, renal injury.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity when used together, particularly in patients with impaired renal function.
* **Warfarin:** Ceftriaxone may decrease the effectiveness of warfarin; monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone serum levels.
* **Calcium-Containing Solutions (IV):** Contraindicated in neonates.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Blood counts.
* Signs of hypersensitivity reactions.
* Biliary symptoms (especially in neonates and prolonged therapy).
## Clinical Pearls
* Ceftriaxone is renally and hepatically eliminated, allowing for flexible dosing in many patients with impaired organ function.
* Due to its long half-life, once-daily dosing is often appropriate for many indications.
* For intramuscular administration, reconstitute with the appropriate diluent and inject deeply into a large muscle mass.
* Never use diluents containing calcium (e.g., Lactated Ringer's) for reconstitution or dilution of ceftriaxone for IV administration, especially in neonates.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and institutional protocols for the most current and comprehensive drug information.
