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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
* Serious infections caused by susceptible organisms, including:
* Pneumonia (community-acquired and hospital-acquired)
* Bacterial meningitis
* Septicemia
* Bone and joint infections
* Intra-abdominal infections
* Skin and soft tissue infections
* Urinary tract infections, including pyelonephritis
* Gonorrhea (uncomplicated cervical/urethral and rectal infections, pelvic inflammatory disease)
* Prophylaxis for surgical infections
### Adult Dosing
* **General infections:** 1 to 2 grams IV/IM every 12 to 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical prophylaxis:** 1 to 2 grams IV given 30 to 120 minutes before surgery.
* **Uncomplicated gonorrhea:** 250 mg IM once.
* **Pelvic inflammatory disease:** 250 mg IM once, followed by an appropriate oral or IV regimen.
### Pediatric Dosing
* **Neonate (0-14 days):** 25-50 mg/kg IV/IM once every 24 hours. Maximum 50 mg/kg/day.
* **Neonate (>14 days) and Children < 12 years:** 50-100 mg/kg/day IV/IM divided every 12 to 24 hours. Maximum 2 grams/day.
* **Children > 12 years:** Dosing is the same as adults.
* **Bacterial meningitis (pediatric):** 100 mg/kg/day IV divided every 12 to 24 hours. Maximum 4 grams/day. (Note: Neonates with meningitis should receive 50 mg/kg/day).
### Dose Adjustments
* No dose adjustment is typically required for renal impairment. However, caution and monitoring are advised as it is primarily eliminated by the kidneys.
* Dosing may need adjustment in severe hepatic impairment, though data is limited.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving IV calcium-containing solutions. Concurrent administration of ceftriaxone and IV calcium-containing solutions in neonates can lead to precipitation of ceftriaxone-calcium salt in the pulmonary and renal vasculature, which can be fatal.
### Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Clostridioides difficile-associated diarrhea, anaphylaxis, Stevens-Johnson syndrome, hepatic dysfunction, biliary sludge/cholelithiasis (especially in neonates and with prolonged therapy), renal tubular necrosis.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity and ototoxicity when used together, particularly in severe infections.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions:** **Contraindicated in neonates.** Avoid concurrent administration in adults, especially those with renal impairment. Separate administration by at least 48 hours if necessary.
### Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count.
* Signs of hypersensitivity reactions.
* For neonates: monitor for signs of biliary or pulmonary precipitation.
### Clinical Pearls
* Ceftriaxone is often a component of empiric therapy for community-acquired pneumonia, meningitis, and intra-abdominal infections.
* It has a long half-life, allowing for once or twice-daily dosing.
* For intramuscular administration, reconstitute with sterile water for injection or 1% lidocaine hydrochloride solution. Do NOT use diluents containing calcium.
* For intravenous administration, reconstitute with sterile water for injection, 0.9% sodium chloride, or 5% dextrose.
**Disclaimer:** This information is intended for clinical use and is not exhaustive. It is crucial to consult the most current prescribing information and relevant guidelines before administering this medication. Dosing and indications may vary based on patient-specific factors and local institutional protocols.
