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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
* Community-acquired pneumonia
* Bacterial meningitis
* Sepsis
* Uncomplicated gonorrhea
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Prophylaxis in surgical settings
## Adult Dosing
* **General:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours, typically administered as 2 grams every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infection, 1 gram IV/IM every 24 hours for 7-10 days.
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **General:** 50-100 mg/kg/day IV/IM divided every 12-24 hours.
* **Severe infections:** Up to 150 mg/kg/day IV divided every 12-24 hours. Maximum daily dose is 4 grams.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
* **Neonates (0-14 days):** 25-50 mg/kg/day IV divided every 24 hours.
* **Neonates (15-28 days):** 50 mg/kg/day IV divided every 12 hours.
* **Note:** Use of ceftriaxone in neonates, particularly premature infants, is controversial due to the risk of kernicterus and precipitation in the lungs and kidneys. Consult specific pediatric guidelines.
## Dose Adjustments
No dose adjustment is generally required for mild to moderate renal or hepatic impairment. In severe renal impairment (CrCl <10 mL/min) not on dialysis, the daily dose should not exceed 2 grams. If the patient is on dialysis, dose and interval adjustments are generally not needed.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (≤ 28 days) receiving IV calcium-containing solutions or infusions due to the risk of precipitate formation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis, pain at injection site.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, cholelithiasis (biliary sludge), eosinophilia, thrombocytopenia, leukopenia, kernicterus (in neonates).
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** May alter INR. Monitor INR closely.
* **Probenecid:** May increase ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated for IV administration in neonates.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea, particularly C. difficile-associated diarrhea.
* Monitor blood counts, liver function tests, and renal function tests periodically, especially with prolonged therapy.
* Monitor for biliary sludge formation in children and adults with prolonged therapy.
## Clinical Pearls
* Ceftriaxone is highly protein-bound, which contributes to its long half-life allowing for once-daily dosing.
* Do not mix or co-administer ceftriaxone with IV calcium-containing solutions. Separate administration by at least 48 hours if both are needed.
* IM administration may be painful; consider lidocaine as the diluent (ensure compatibility and appropriate formulation).
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*This information is intended for healthcare professionals. Always verify current prescribing information and institutional protocols before initiating treatment.*
