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# Cefriaxone
## Overview
Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic with high activity against Gram-negative bacteria and moderate activity against Gram-positive bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Bacterial meningitis (including *Neisseria meningitidis*, *Haemophilus influenzae*, and *Streptococcus pneumoniae*)
* Pneumonia (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections (complicated and uncomplicated)
* Sepsis and bacteremia
* Gonorrhea (uncomplicated)
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams IV/IM every 12 to 24 hours.
* **Severe Infections:** Doses up to 4 grams IV per day, divided every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 250 mg IM as a single dose.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30 to 120 minutes before incision.
Maximum daily dose: 4 grams.
## Pediatric Dosing
* **Neonates (< 28 days):** 25 to 50 mg/kg IV/IM every 24 hours.
* **Children (15 days to 12 years):** 50 to 100 mg/kg IV/IM every 12 to 24 hours.
* **Children weighing > 50 kg:** Use adult doses.
* **Severe Infections/Meningitis:** Up to 100 mg/kg IV per day, divided every 12 hours (maximum 2 grams per day).
Maximum daily dose for pediatric patients depends on weight, but generally should not exceed the adult maximum of 4 grams.
**Note:** Ceftriaxone is contraindicated in neonates (term and preterm) receiving IV calcium-containing solutions or infusions, due to risk of precipitation.
## Dose Adjustments
No dose adjustment is typically necessary for renal impairment. However, in severe renal impairment or hepatic impairment, caution may be warranted and monitoring may be considered, although it is largely renally excreted.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (term and preterm) receiving IV calcium-containing solutions or infusions.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, elevated liver enzymes.
* **Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, seizure (rare), biliary sludge or pseudolithiasis (especially in neonates and children), phlebitis at IV site.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity or ototoxicity, especially with high doses or prolonged therapy.
* **Warfarin:** May alter the anticoagulant effect; monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone serum levels.
* **Calcium-containing solutions:** Contraindicated for co-administration in neonates.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of *C. difficile*-associated diarrhea.
* Monitor liver function tests and CBC if therapy is prolonged.
* Monitor for signs of biliary sludge or complications in pediatric patients, particularly neonates.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice daily dosing.
* It can be administered intramuscularly, often with lidocaine to reduce injection site pain.
* Ceftriaxone is the drug of choice for uncomplicated gonorrhea.
* Due to its potential to cause biliary sludge, it's important to consider alternative agents in pregnant women if clinically feasible, and to monitor infants exposed in utero if symptoms develop.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical judgment. Always verify current prescribing information and local protocols before administering any medication.*
