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## Cefriaxone
### Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is administered via intramuscular (IM) or intravenous (IV) routes.
### Primary Indications
* Lower respiratory tract infections (e.g., pneumonia)
* Skin and skin structure infections
* Urinary tract infections
* Bacterial meningitis
* Sepsis
* Gonorrhea
* Pelvic inflammatory disease
* Preoperative prophylaxis
### Adult Dosing
* **General Infections:** 1 to 2 grams (g) every 12 to 24 hours (IV or IM).
* **Serious Infections:** Up to 4 g daily, typically divided into two 2 g doses every 12 hours.
* **Meningitis:** 2 g every 12 hours (IV).
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infection, 1 g IV or IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 g IV or IM 30 to 120 minutes before surgery.
### Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg per day IV or IM, divided every 24 hours. Maximum 50 mg/kg/day.
* **Neonates (>14 days) and Children (<12 years):** 50 to 100 mg/kg per day IV or IM, divided every 12 to 24 hours. Maximum 2 g/day.
* **Children with Meningitis:** 100 mg/kg per day (maximum 4 g/day), divided every 12 hours.
* **Children with Gonorrhea:** 125 mg IM as a single dose.
*Note: Specific dosing for pediatric populations can vary based on indication and local protocols.*
### Dose Adjustments
No dose adjustment is required in patients with hepatic or renal impairment, as ceftriaxone is cleared by both routes. However, caution is advised in severe renal impairment with concomitant hepatic dysfunction.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactams.
* Neonates (≤ 41 weeks postmenstrual age) with hyperbilirubinemia or hypoalbuminemia should not receive IV ceftriaxone, particularly if they are receiving calcium-containing solutions.
### Adverse Effects
* **Common:** Diarrhea, rash, injection site reactions (pain, phlebitis), eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridioides difficile-associated diarrhea, biliary sludge or pseudolithiasis, renal impairment, hepatic dysfunction, hemolytic anemia.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used concurrently, especially in severe infections or in patients with compromised renal function.
* **Warfarin:** Ceftriaxone may alter the anticoagulant response. Monitor INR closely.
* **Calcium-containing solutions (IV):** Concurrent administration via Y-site is contraindicated due to risk of precipitation. Ceftriaxone should be flushed with a compatible solution before and after administration of calcium-containing solutions.
### Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for effectiveness of treatment (resolution of infection signs and symptoms).
* Monitor for adverse effects, particularly diarrhea and injection site reactions.
* Consider liver function tests and renal function tests in prolonged therapy or in patients with risk factors.
### Clinical Pearls
* Ceftriaxone's long half-life allows for once or twice-daily dosing.
* IM administration may be painful; consider lidocaine as a diluent if appropriate and not contraindicated.
* Biliary pseudolithiasis can occur and may be mistaken for cholelithiasis. It is generally transient and resolves after discontinuation of the drug.
* Neonatal hyperbilirubinemia is a significant concern with ceftriaxone.
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*Please verify the current prescribing information with the official drug monograph or other reliable sources before making clinical decisions.*
