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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 intravenously or intramuscularly.
## Primary Indications
* **Bacterial meningitis:** Including Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae.
* **Pneumonia:** Community-acquired pneumonia and hospital-acquired pneumonia.
* **Sepsis:** When appropriate based on suspected pathogens.
* **Skin and soft tissue infections:** Uncomplicated and complicated.
* **Urinary tract infections:** Including pyelonephritis.
* **Gonorrhea:** Uncomplicated and complicated.
* **Lyme disease:** Early and late disseminated stages.
## Adult Dosing
* **General infections:** 1 to 2 grams intravenously or intramuscularly every 12 to 24 hours.
* **Meningitis:** 2 grams intravenously every 12 hours. Maximum daily dose is 4 grams.
* **Gonorrhea:** 500 mg intramuscularly as a single dose for uncomplicated urogenital or rectal infections. For disseminated gonococcal infections, 1 gram intravenously or intramuscularly every 24 hours for 7 days.
* **Surgical prophylaxis:** 1 to 2 grams intravenously 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg intravenously every 24 hours. Avoid concomitant use with IV calcium-containing solutions.
* **Neonates (15-28 days):** 50 mg/kg intravenously every 24 hours. Avoid concomitant use with IV calcium-containing solutions.
* **Infants and Children (>28 days to 12 years or <50 kg):**
* **Meningitis:** 100 mg/kg intravenously every 12 to 24 hours. Maximum daily dose is 4 grams.
* **Other infections:** 50-100 mg/kg intravenously or intramuscularly every 12 to 24 hours. Maximum daily dose is 2 grams.
* **Children >12 years or weighing >50 kg:** Use adult dosing.
## Dose Adjustments
No dose adjustment is required for renal or hepatic impairment. However, caution and monitoring are advised in severe cases.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (especially premature) receiving IV calcium-containing solutions or tube feedings due to risk of ceftriaxone-calcium precipitates.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, thrombocytosis, eosinophilia, elevated liver enzymes.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge or pseudolithiasis (especially in children), hemolytic anemia, interstitial nephritis.
## Key Drug Interactions
* **Probenecid:** May increase ceftriaxone levels.
* **Aminoglycosides:** Increased risk of nephrotoxicity when used concurrently, though some evidence suggests a potential synergistic effect against certain gram-negative organisms.
* **Warfarin:** May alter anticoagulant effect. Monitor INR.
* **Calcium-containing solutions (IV):** Contraindicated in neonates due to risk of precipitation.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for gastrointestinal side effects, especially diarrhea.
* Monitor liver function tests and complete blood count periodically.
* Monitor for signs of phlebitis at the IV insertion site.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice daily dosing.
* Intramuscular administration is generally well-tolerated and can be a good option for outpatient therapy.
* When reconstituting, use appropriate diluent (e.g., sterile water for injection, bacteriostatic water for injection).
* Reconstituted solutions are stable for a specified time; consult product information for details.
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*Disclaimer: This information is intended for clinical pharmacy professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and institutional protocols before making any treatment decisions.*
