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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
* Serious bacterial infections including:
* Pneumonia (community-acquired and hospital-acquired)
* Bacterial meningitis
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Intra-abdominal infections
* Gonococcal infections
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams IV/IM every 24 hours.
* **Severe or life-threatening infections:** Up to 4 grams IV every 24 hours (administered as 2 grams every 12 hours).
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Disseminated gonococcal infection:** 1 gram IV/IM every 24 hours for 7 days.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical prophylaxis:** 1 to 2 grams IV/IM 30-60 minutes prior to incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg IV/IM every 24 hours. Avoid concomitant IV calcium-containing solutions.
* **Neonates (15-28 days) and children:** 50 to 100 mg/kg IV/IM every 24 hours. Maximum 2 grams daily.
* **Severe infections and meningitis in children:** Up to 80 to 100 mg/kg/day IV/IM, administered in divided doses every 12 hours. Maximum 4 grams daily.
## Dose Adjustments
* **Renal impairment:** No dose adjustment is generally needed due to high biliary excretion. However, in severe renal impairment (CrCl < 10 mL/min) not undergoing hemodialysis, the daily dose should not exceed 2 grams.
* **Hepatic impairment:** No dose adjustment is generally needed. Use with caution in severe hepatic impairment.
* **Combined renal and hepatic impairment:** Use with caution. Monitor drug levels if available.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (especially premature) receiving IV calcium-containing solutions or medications due to the risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, injection site pain/phlebitis, eosinophilia, thrombocytosis.
* **Serious:** *Clostridioides difficile*-associated diarrhea, Stevens-Johnson syndrome, anaphylaxis, cholelithiasis (especially in neonates), biliary sludge, hemolytic anemia, pancreatitis, renal tubular necrosis, seizures (rare).
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity and ototoxicity when used together, especially in severe infections. Monitor renal function and drug levels.
* **Oral anticoagulants (e.g., warfarin):** Ceftriaxone may potentiate the effect of anticoagulants. Monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone plasma levels.
* **Calcium-containing solutions/products:** Contraindicated in neonates due to risk of fatal precipitation in lungs and kidneys. In adults, administer IV ceftriaxone and IV calcium-containing solutions through separate IV lines or flush the line between administrations.
## Monitoring
* Renal and hepatic function.
* Signs and symptoms of infection.
* Bowel function for *C. difficile*.
* Monitor for signs of hypersensitivity reactions.
* Consider monitoring prothrombin time/INR in patients at risk for bleeding or those on anticoagulants.
## Clinical Pearls
* Ceftriaxone is renally and hepatically cleared, allowing for less frequent dosing (once daily).
* The risk of biliary sludge and cholelithiasis is higher with higher doses and longer durations of therapy, particularly in neonates. This is usually asymptomatic and resolves after discontinuation.
* The potential for cephalosporin-associated hemolytic anemia exists.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
