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# Ceftriaxone
## Overview
Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic with activity against many Gram-positive and Gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Meningitis (bacterial)
* Bone and joint infections
* Intra-abdominal infections
* Skin and skin structure infections
* Urinary tract infections
* Gonorrhea
* Sepsis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 250 mg IM as a single dose.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30 to 60 minutes before surgery.
## Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg IV every 24 hours. **Do not exceed 50 mg/kg/day.**
* **Neonates (15-28 days):** 50 mg/kg IV every 24 hours. If larger dose is needed, consider every 12-hour dosing.
* **Children (≥15 days and <125 kg):**
* **General Infections:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours.
* **Severe Infections:** Up to 150 mg/kg/day IV divided every 12 to 24 hours. **Maximum daily dose 4 grams.**
* **Meningitis:** 100 mg/kg/day IV divided every 12 to 24 hours.
* **Children weighing ≥125 kg:** Use adult dosing.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment. However, monitor closely in severe cases of either.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates (less than 28 days old) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, phlebitis at injection site.
Serious: Anaphylaxis, *Clostridioides difficile*-associated diarrhea, biliary sludge/cholelithiasis, eosinophilia, thrombocytosis, leukopenia, hemolytic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity or ototoxicity when used together, though data are mixed.
* **Oral Contraceptives:** Ceftriaxone may decrease the efficacy of oral contraceptives. Advise alternative non-hormonal contraception.
* **Warfarin:** May alter INR. Monitor INR closely.
* **Calcium-Containing Solutions:** **Contraindicated in neonates.** In adults, separate infusions by at least 48 hours or administer via different IV lines to avoid precipitation.
## Monitoring
* Assess for signs and symptoms of infection resolution.
* Monitor for adverse effects, particularly hypersensitivity reactions and gastrointestinal disturbances.
* Monitor renal and hepatic function periodically, especially with prolonged therapy or in patients with pre-existing impairment.
* Monitor for signs of *C. difficile* infection.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing.
* For IM administration, reconstitute with appropriate diluent and inject deeply into a large muscle mass.
* For IV administration, administer over 30 minutes.
* Can be used for empiric treatment of many serious bacterial infections.
* Dosing for specific indications such as endocarditis or Lyme disease may differ based on treatment guidelines and local protocols.
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*Please verify current prescribing information and consult relevant guidelines for definitive treatment decisions.*
