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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
* Treatment of serious infections including: meningitis, pneumonia, sepsis, skin and soft tissue infections, bone and joint infections, intra-abdominal infections, urinary tract infections, and gonorrhea.
* Surgical prophylaxis.
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Serious Infections (e.g., meningitis):** Up to 4 grams IV every 24 hours, typically given as 2 grams every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose. For disseminated gonococcal infection, dosing may be higher and for longer duration.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (< 7 days):** 25 to 50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Infants and Children (> 7 days):**
* **Bacterial Meningitis:** 100 mg/kg IV every 12 to 24 hours (maximum 4 grams/day).
* **Other Serious Infections:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours (maximum 4 grams/day).
* Dosing for pediatric uncomplicated gonorrhea is 125 mg IM single dose.
## Dose Adjustments
No dose adjustment is typically needed for renal or hepatic impairment, as ceftriaxone is extensively metabolized by the liver and excreted in bile, and a portion is renally excreted. However, caution and monitoring are advised in severe hepatic or renal dysfunction.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (birth to 28 days) receiving IV calcium-containing solutions concurrently or through the same IV line due to risk of precipitation.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, phlebitis.
Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), hemolytic anemia, biliary sludging/cholelithiasis, elevated liver enzymes, eosinophilia, leukopenia, thrombocytopenia.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity and ototoxicity, particularly with high doses or prolonged therapy.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Oral Contraceptives:** May decrease efficacy.
* **Calcium-containing solutions:** Contraindicated in neonates (see Contraindications).
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (baseline and periodically, especially with prolonged therapy or in patients with pre-existing organ dysfunction).
* Complete blood count.
* Monitor for hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone is a frequently used antibiotic for empiric coverage of common community-acquired and hospital-acquired infections.
* Due to its long half-life, it can often be dosed every 24 hours for many indications, which can simplify administration.
* Biliary sludging is a known, often asymptomatic, side effect, particularly in children and with prolonged therapy.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines for complete details and to ensure patient safety.*
