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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
* Pneumonia
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Sepsis
* Gonorrhea and syphilis
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours (divided into two 2-gram doses every 12 hours).
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Syphilis:** 2 to 3 grams IV or IM every 24 hours for 10 to 14 days (duration depends on stage of syphilis).
* **Surgical Prophylaxis:** 1 to 2 grams IV within 60 minutes before incision.
## Pediatric Dosing
* **Neonates (<7 days old):** 25 to 50 mg/kg IV every 24 hours.
* **Infants and Children (>7 days old, <125 kg):**
* **General Infections:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours. Maximum daily dose is 2 grams.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours. Maximum daily dose is 4 grams.
* **Neonatal Jaundice:** Ceftriaxone is contraindicated in neonates with hyperbilirubinemia due to the risk of bilirubin encephalopathy.
## Dose Adjustments
No dose adjustment is typically required for renal impairment, as ceftriaxone is largely eliminated by hepatic metabolism and biliary excretion. However, in severe hepatic impairment with significant renal dysfunction, the dose may need to be reduced.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates with hyperbilirubinemia.
* Concurrent use with IV calcium-containing solutions in neonates (risk of precipitates).
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, injection site pain or phlebitis.
* **Serious:**
* *Clostridioides difficile*-associated diarrhea.
* Eosinophilia, thrombocytosis, leukopenia.
* Biliary sludge or gallstones (especially with prolonged therapy).
* Hemolytic anemia.
* Seizures (rare, usually with high doses).
* Anaphylaxis.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin; increased INR monitoring is needed.
* **Probenecid:** May increase ceftriaxone levels.
* **Oral Contraceptives:** Ceftriaxone may decrease the efficacy of oral contraceptives.
* **Calcium-containing Solutions:** Contraindicated in neonates due to risk of fatal precipitates. Careful consideration is needed in adults with impaired renal function or compromised hepatic function.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of *C. difficile*-associated diarrhea.
* Monitor complete blood count and liver function tests with prolonged therapy.
* Monitor for signs of biliary sludge or gallstone formation, especially in pediatric patients.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing.
* Due to its biliary excretion, it is effective for certain biliary tract infections.
* It is the preferred agent for uncomplicated gonorrhea and early syphilis.
* Avoid mixing or administering ceftriaxone simultaneously with calcium-containing solutions through the same IV line, except in neonates where it is strictly contraindicated.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete details and to ensure patient safety.*
