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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
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Skin and skin structure infections
* Urinary tract infections (including pyelonephritis)
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Bacterial meningitis (adjunctive therapy)
* Sepsis
* Prophylaxis for surgical infections
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infection, 1 gram IV or IM every 24 hours for 7 days.
* **Meningitis:** 2 grams IV every 12 hours. Duration depends on pathogen and clinical response.
Dosing for specific infections may vary based on susceptibility patterns and clinical guidelines.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days):** 50 mg/kg IV every 24 hours.
* **Children (>28 days and <12 years or <50 kg):**
* **General Infections:** 50-100 mg/kg/day IV or IM divided every 12 to 24 hours.
* **Severe Infections:** Up to 150 mg/kg/day IV divided every 8 to 12 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
* **Children (>12 years or >50 kg):** Use adult doses.
Note: In neonates, ceftriaxone should not be administered with calcium-containing solutions or administered simultaneously with calcium-containing solutions, even through different infusion lines.
## Dose Adjustments
No dose adjustment is typically required for hepatic impairment or renal impairment unless both are severe. If creatinine clearance is less than 10 mL/minute, the usual dose should be given every 24 hours.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates with hyperbilirubinemia, particularly premature infants, due to the risk of kernicterus.
* Concomitant use of IV calcium-containing solutions in neonates.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, phlebitis at injection site, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Clostridium difficile-associated diarrhea, anaphylaxis, Stevens-Johnson syndrome, hepatic dysfunction, biliary sludge, renal dysfunction, seizures (rare).
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may alter the anticoagulant effect of warfarin; monitor INR closely.
* **Probenecid:** Can increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions:** Contraindicated in neonates.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for development of diarrhea, especially if severe or bloody, to rule out C. difficile infection.
* Monitor liver and renal function tests, especially with prolonged therapy or in patients with pre-existing impairment.
* Monitor INR if patient is on warfarin.
## Clinical Pearls
* Ceftriaxone is generally well-tolerated.
* It is one of the few antibiotics that can be dosed once daily for many infections, improving patient compliance.
* The long half-life allows for less frequent dosing.
* Reconstitution with specific diluents is required for IV and IM administration; follow manufacturer's instructions.
* Biliary pseudolithiasis (biliary sludge) is a known, usually reversible, adverse effect, particularly in children.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making clinical decisions. Dosing can vary based on patient-specific factors and local protocols.*
