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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, meningitis, sepsis, and skin and soft tissue infections.
* Urinary tract infections.
* Gonorrhea.
* Prophylaxis for surgical infections.
## Adult Dosing
* **General infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections:** Doses up to 4 grams IV daily, divided every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Complicated gonorrhea:** 1 gram IM or IV every 24 hours for 3-7 days.
* **Surgical prophylaxis:** 1-2 grams IV or IM 30-60 minutes before surgery.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Avoid IV use with calcium-containing solutions.
* **Neonates (15-28 days):** 50 mg/kg IV every 24 hours. Avoid IV use with calcium-containing solutions.
* **Children >28 days:** 50-100 mg/kg IV or IM daily, not to exceed 2 grams daily.
* **Severe infections (children):** Doses up to 100 mg/kg IV daily, divided every 12 hours, not to exceed 4 grams daily.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, as ceftriaxone is cleared by both mechanisms. However, cautious dosing may be considered in severe impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (< 41 weeks postmenstrual age) receiving IV ceftriaxone with concomitant IV calcium-containing solutions due to the risk of fatal precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at the injection site, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Clostridium difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), biliary sludge/cholelithiasis, hemolytic anemia, renal and hepatic toxicity (rare).
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity or ototoxicity, especially with prolonged coadministration. Monitor levels.
* **Warfarin:** Ceftriaxone may alter the anticoagulant effect of warfarin. Monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions/products (in neonates):** Fatal precipitation in lungs and kidneys has been reported. Do not administer concurrently via Y-site or to the same infusion line.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for effectiveness (clinical improvement).
* Monitor for adverse effects, including gastrointestinal disturbances and injection site reactions.
* In neonates, monitor for signs of biliary precipitation.
## Clinical Pearls
* Ceftriaxone is often a choice for empiric therapy due to its broad spectrum and convenient once-daily dosing.
* When reconstituting, use appropriate diluents (e.g., sterile water for injection, bacteriostatic water for injection, 0.9% sodium chloride). Reconstituted solutions are typically stable for 24 hours at room temperature or 3 days refrigerated.
* For IM administration, dilute with 1% lidocaine hydrochloride solution to minimize pain. Do not administer IM to infants.
* In patients with severe biliary obstruction or hepatic failure, the half-life may be prolonged.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for complete details and to verify dosage before administration.*
