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# Ceftriaxone
## 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
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Pelvic inflammatory disease
* Gonorrhea (disseminated and uncomplicated)
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams (g) intravenously (IV) or intramuscularly (IM) every 12 to 24 hours. Doses up to 4 g daily have been used in severe infections.
* **Meningitis:** 2 g IV every 12 hours.
* **Surgical prophylaxis:** 1 to 2 g IV or IM given 30 to 120 minutes before surgery.
## Pediatric Dosing
Dosing for pediatric patients is weight-based and depends on the indication and severity of infection. Consult specific pediatric guidelines or institutional protocols.
* **Neonates (≤ 7 days):** 25 to 50 mg/kg IV every 24 hours. Avoid concurrent IV calcium-containing solutions.
* **Infants and Children (> 7 days):**
* **Meningitis:** 100 mg/kg IV every 12-24 hours (max 4 g/day).
* **Other infections:** 50 to 100 mg/kg IV or IM every 12-24 hours (max 2 g/day).
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, as ceftriaxone is extensively protein-bound and eliminated by both routes. However, extreme impairment may warrant monitoring.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving IV calcium-containing solutions (risk of ceftriaxone-calcium precipitation). This includes neonates receiving parenteral nutrition containing calcium.
## Adverse Effects
Common: Diarrhea, rash, phlebitis (with IV infusion), eosinophilia, thrombocytosis.
Serious: Clostridium difficile-associated diarrhea, biliary sludge or pseudolithiasis, anaphylaxis, hemolytic anemia, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** May have additive or synergistic bactericidal activity, but also increased nephrotoxicity risk.
* **Warfarin:** Ceftriaxone may enhance the anticoagulant effect of warfarin. Monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** As noted above, contraindicated in neonates due to risk of precipitation. Use caution in adults, especially with parenteral nutrition.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for development of diarrhea and assess for C. difficile.
* Monitor renal and liver function tests if clinically indicated.
* Monitor coagulation parameters if patient is on anticoagulants.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once or twice daily dosing.
* It is the drug of choice for disseminated gonococcal infections.
* Reconstituted solutions should be protected from light.
* Do NOT mix or administer ceftriaxone simultaneously with calcium-containing solutions, even at different IV sites or infusion lines, especially in neonates. If coadministration is necessary, flush the infusion line thoroughly between administrations.
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*Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the most current prescribing information, local protocols, and a healthcare provider before making any decisions regarding patient care.*
