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## Cefriaxone (Ceftriaxone)
### Overview
Ceftriaxone is a third-generation cephalosporin antibiotic. It is administered intravenously or intramuscularly.
### Primary Indications
* Bacterial meningitis
* Community-acquired pneumonia
* Complicated urinary tract infections (UTIs)
* Skin and soft tissue infections
* Bone and joint infections
* Sepsis
* Gonorrhea (uncomplicated)
* Lyme disease
### Adult Dosing
* **General:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Serious Infections:** Up to 4 grams IV every 24 hours, typically divided as 2 grams every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose. (For disseminated gonococcal infections, higher doses and longer durations may be required).
* **Lyme Disease (Disseminated):** 2 grams IV every 24 hours for 14 to 30 days.
### Pediatric Dosing
Dosing is weight-based and depends on the indication. Specific pediatric dosing protocols should be consulted.
* **General (non-meningeal):** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours. Maximum 2 grams/day.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours. Maximum 4 grams/day.
* **Neonates (< 7 days or < 2000g):** 25 mg/kg/dose IV every 24 hours.
* **Neonates (7-28 days or > 2000g):** 50 mg/kg/dose IV every 24 hours.
### Dose Adjustments
No dose adjustment is necessary for hepatic or renal impairment. However, in severe renal impairment (CrCl < 10 mL/min) and concomitant hepatic dysfunction, doses greater than 2 grams/day should be used cautiously.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (gestational age ≤ 41 weeks) receiving IV calcium-containing solutions or infusions.
### Adverse Effects
* **Common:** Diarrhea, rash, eosinophilia, thrombocytosis.
* **Serious:** Biliary sludging (especially in neonates), anaphylaxis, Clostridioides difficile infection, hematologic abnormalities, seizure.
### Key Drug Interactions
* **Calcium-containing Solutions/Products:** Contraindicated in neonates due to risk of precipitation in the lungs and kidneys. In adults, though less common, co-administration should be done cautiously, and infusions should not be mixed or administered together via the same IV line.
* **Aminoglycosides:** Potential for additive nephrotoxicity and ototoxicity.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR.
### Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for gastrointestinal side effects, especially C. difficile diarrhea.
* Monitor for hematologic changes.
* Monitor for signs of biliary sludging, particularly in neonates and during prolonged therapy.
### Clinical Pearls
* Ceftriaxone does not require dose adjustment in renal or hepatic impairment, making it a convenient choice in many patients.
* The long half-life allows for once-daily dosing in most indications.
* Pain with IM injection can be significant; consider reconstituting with 1% lidocaine (not for IV use).
* Avoid concurrent use of ceftriaxone and calcium-containing solutions in neonates.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.*
