Please check your internet connection and try again.
# Cefriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria.
## Primary Indications
* Lower respiratory tract infections
* Skin and soft tissue infections
* Urinary tract infections
* Meningitis (bacterial)
* Bacterial sepsis
* Pelvic inflammatory disease
* Disseminated gonococcal infections
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 12 or 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours (usually divided into two 2-gram doses).
* **Meningitis:** 2 grams IV every 12 hours.
* **Disseminated Gonococcal Infections:** 1 gram IM/IV single dose.
* **Surgical Prophylaxis:** 1-2 grams IV/IM 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (<7 days):** 25-50 mg/kg IV every 24 hours. Maximum 50 mg/kg/day.
* **Infants and Children (>7 days):**
* **General Infections:** 50-100 mg/kg/day IV/IM divided every 12 or 24 hours. Maximum 2 grams/day.
* **Severe Infections:** Up to 80-100 mg/kg/day IV divided every 12 or 24 hours. Maximum 4 grams/day.
* **Meningitis:** 80-100 mg/kg/day IV divided every 12 or 24 hours. Maximum 4 grams/day.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment. However, caution is advised in severe cases of both.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 41 weeks corrected gestational age) receiving IV calcium-containing solutions or infusions, due to risk of precipitation.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, phlebitis (with IV administration), eosinophilia, thrombocytosis, leukopenia.
Serious: Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge/cholelithiasis (especially in neonates), kernicterus (in neonates), Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Warfarin:** May alter INR. Monitor INR closely.
* **Calcium-containing solutions/products:** Avoid concurrent administration via IV line or in separate infusions in neonates.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (baseline and periodically, especially in severe impairment).
* Blood counts.
* Prothrombin time/INR if patient is on anticoagulants or has coagulation abnormalities.
* Monitor for signs of C. difficile infection.
## Clinical Pearls
* Ceftriaxone is highly protein-bound, which can affect its efficacy in certain situations.
* Due to its long half-life, once-daily dosing is common for many indications.
* For IM administration, lidocaine can be used as the diluent to reduce injection site pain.
* Ensure adequate hydration in patients receiving high doses.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.*
