Please check your internet connection and try again.
# 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)
* Meningitis (bacterial)
* Bone and joint infections
* Intra-abdominal infections
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Sepsis
* Gonorrhea (uncomplicated)
* Surgical prophylaxis
## 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 per day, divided every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1 to 2 grams IV administered 30 to 120 minutes before incision.
* **Gonorrhea:** 500 mg IM single dose (for uncomplicated cases). For disseminated gonococcal infection, 1 gram IV or IM daily for 7 days may be considered.
Dosing frequency and duration depend on the type and severity of infection, and the specific pathogen.
## Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg IV every 24 hours. Maximum 50 mg/kg/day.
* **Neonates (15-28 days):** 25 to 50 mg/kg IV every 12 to 24 hours.
* **Infants and Children (>28 days):**
* **General Infections:** 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.
* **Uncomplicated Gonorrhea:** 125 mg IM single dose.
Dosing in pediatric patients should be guided by institutional protocols and clinical response.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment. However, severe impairment may warrant closer monitoring.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (gestational age < 41 weeks) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Clostridium difficile-associated diarrhea, cholelithiasis (biliary sludge), hemolytic anemia, anaphylaxis, seizure (rare, often associated with high doses).
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity and ototoxicity, especially with high doses or in patients with renal impairment. Monitor renal function and drug levels.
* **Warfarin:** Ceftriaxone may alter the anticoagulant effect of warfarin. Monitor INR closely.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of fatal precipitation in lungs and kidneys. Separate administration in adults; do not mix or administer concurrently.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function, especially in patients with pre-existing impairment or receiving concurrent nephrotoxic agents.
* Signs of hypersensitivity reactions.
* Stool for C. difficile if diarrhea develops.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine, though lidocaine may reduce injection site pain.
* Due to its long half-life, once-daily dosing is often appropriate for many infections.
* Biliary sludge formation is a potential, often asymptomatic, complication, particularly with prolonged therapy.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for complete and current drug information.*
