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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
* Skin and soft tissue infections
* Pneumonia
* Meningitis (bacterial)
* Gonorrhea and other sexually transmitted infections
* Urinary tract infections
* Bone and joint infections
* Sepsis
* Prophylaxis for surgical procedures
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 12-24 hours.
* **Severe Infections:** Up to 4 grams IV daily, divided every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. (For disseminated gonococcal infections, dosing varies.)
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes prior to incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. **Do not exceed 50 mg/kg/day.**
* **Neonates (15-28 days):** 25-50 mg/kg IV every 12-24 hours.
* **Children (>28 days):** 50-100 mg/kg/day IV or IM, divided every 12-24 hours. Maximum 2 grams daily.
* **Severe Infections/Meningitis (Children >28 days):** Up to 100 mg/kg/day IV, divided every 12 hours. Maximum 4 grams daily.
*Note: Dosing for neonates depends on gestational age and postnatal age. Avoid IV administration with calcium-containing solutions in neonates.*
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally required, as ceftriaxone is primarily eliminated by hepatic excretion. However, monitor closely in severe renal impairment, especially if hepatic function is also compromised.
* **Hepatic Impairment:** No dose adjustment is generally required. Monitor closely in severe hepatic impairment, especially if renal function is also compromised.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* **Neonates receiving IV calcium-containing solutions or requiring IV infusion of calcium-containing products.**
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludging (especially in neonates and children), hemolytic anemia (rare), Stevens-Johnson syndrome, anaphylaxis.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity, though data is mixed.
* **Warfarin:** Ceftriaxone may affect prothrombin time; monitor INR closely.
* **Live Typhoid Vaccine:** Ceftriaxone may reduce the efficacy of the vaccine.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (especially in severe impairment or prolonged therapy).
* Complete blood count (CBC) periodically during prolonged therapy.
* Prothrombin time/INR if patient is on anticoagulants or has coagulopathy.
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine; however, lidocaine can be used to reduce injection site pain.
* Do not mix ceftriaxone with calcium-containing solutions in the same IV line or administration set, particularly in neonates.
* Biliary sludging can occur and may be asymptomatic or mimic cholecystitis. This is usually reversible after discontinuation of the drug.
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*Disclaimer: This information is intended for healthcare professionals and does not replace professional medical advice. Always consult the most current prescribing information and institutional guidelines for definitive patient care decisions.*
