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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.
### Primary Indications
* Bacterial meningitis
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Complicated urinary tract infections (including pyelonephritis)
* Skin and soft tissue infections
* Bone and joint infections
* Sepsis
* Gonorrhea
* Perioperative prophylaxis
### Adult Dosing
* **General infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections (e.g., meningitis, sepsis):** 2 grams IV every 12 hours (total daily dose up to 4 grams).
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infection, 1 gram IV/IM every 24 hours for 7 days.
* **Perioperative prophylaxis:** 1 to 2 grams IV 30-60 minutes prior to surgical incision.
### Pediatric Dosing
* **Neonates (< 28 days):** 25 to 50 mg/kg IV every 24 hours. Doses exceeding 50 mg/kg should be given every 12 hours due to immature hepatic and renal clearance. **Do not use in hyperbilirubinemic neonates.**
* **Infants and Children (> 28 days):**
* **General infections:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours. Maximum daily dose: 2 grams.
* **Severe infections (e.g., meningitis):** 80 to 100 mg/kg/day IV divided every 12 hours. Maximum daily dose: 4 grams.
* **Uncomplicated gonorrhea:** 125 mg IM as a single dose.
### Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally necessary in adults with impaired renal function, as ceftriaxone undergoes non-renal elimination (hepatic). However, in severe renal impairment with hepatic dysfunction, dose reduction may be considered.
* **Hepatic Impairment:** No dose adjustment is generally necessary in adults with impaired hepatic function.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Use in neonates (especially premature) receiving IV calcium-containing solutions or undergoing blood transfusions due to risk of precipitation.
### Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at the injection site, eosinophilia, thrombocytosis.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludge/cholelithiasis (especially in children), Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, Agranulocytosis, hemolytic anemia, pancreatitis.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used concurrently, particularly in patients with renal dysfunction. Monitor renal function closely.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Oral Contraceptives:** Reduced efficacy of oral contraceptives. Advise alternative contraception.
* **Calcium-containing Solutions:** Contraindicated in neonates due to risk of precipitation in pulmonary and renal vasculature.
### Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for diarrhea and consider *C. difficile* testing if indicated.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing organ dysfunction.
* Monitor for signs of biliary sludge or cholelithiasis, particularly in pediatric patients.
### Clinical Pearls
* Ceftriaxone is renally and hepatically eliminated, allowing for less frequent dosing (once or twice daily).
* Can be reconstituted with lidocaine for IM administration to reduce injection site pain.
* Do not mix or administer ceftriaxone simultaneously with calcium-containing solutions in any patient population, except for specific IV infusions in adults where the lines are flushed between administrations.
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**Disclaimer:** This information is intended for clinical decision support and does not replace professional medical judgment or a thorough review of the most current prescribing information. Always verify current dosing, indications, and safety information with the official drug product labeling or a reliable drug information resource.
