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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.
## Primary Indications
* Bacterial meningitis
* Community-acquired pneumonia
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections (complicated and uncomplicated)
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe Infections:** May increase to 4 grams IV daily, given as 2 grams every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM in a single dose (for uncomplicated urogenital, rectal, and pharyngeal infections).
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes before surgical incision.
## Pediatric Dosing
* **Neonates (< 2 weeks):** 25-50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (2-4 weeks):** 50 mg/kg IV every 24 hours. May increase to 75 mg/kg/day if clinically indicated, divided every 12 hours.
* **Pediatric Patients (> 4 weeks):** 50-100 mg/kg/day IV or IM, divided every 12-24 hours. Maximum daily dose is 4 grams. For meningitis, doses up to 100 mg/kg/day (maximum 4 grams/day) divided every 12 hours are used. Dosing for specific indications may vary and should follow local protocols.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally needed when hepatic function is adequate. If both renal and hepatic function are severely impaired, the total daily dose should not exceed 2 grams.
* **Hepatic Impairment:** No dose adjustment is generally needed when renal function is adequate.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (< 41 weeks post-conceptional age) receiving IV calcium-containing solutions or infusions.
* Neonates (0-28 days) requiring concurrent treatment with IV calcium-containing solutions.
## Adverse Effects
* **Common:** Diarrhea, rash, eosinophilia, thrombocytosis, phlebitis at the injection site.
* **Serious:** Anaphylaxis, *Clostridioides difficile*-associated diarrhea, biliary pseudolithiasis (especially in children), hemolytic anemia, seizures (rare, usually with high doses).
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity.
* **Oral Anticoagulants (e.g., Warfarin):** Ceftriaxone may decrease vitamin K production, potentially enhancing the effect of anticoagulants. Monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing Solutions:** Contraindicated in neonates. Concurrent administration in adults may lead to precipitation.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (especially with prolonged therapy or in patients with pre-existing impairment).
* Prothrombin time/INR if patient is on anticoagulants.
* For signs of hypersensitivity or severe adverse reactions.
## Clinical Pearls
* Ceftriaxone is often a preferred agent for empiric treatment of community-acquired pneumonia and meningitis due to its broad spectrum and convenient once-daily dosing.
* Due to its long half-life, it can be administered once daily for most indications.
* It is a common choice for outpatient parenteral antimicrobial therapy (OPAT) due to IM administration availability and once-daily dosing.
* Ensure adequate hydration during administration to minimize risk of precipitation.
* For IM administration, lidocaine may be used as a diluent to reduce injection pain.
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*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information and consult with a pharmacist or physician for specific patient care decisions.*
