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
* Bacterial meningitis
* Pneumonia (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections, including pyelonephritis
* Intra-abdominal infections
* Sepsis
* Gonorrhea (uncomplicated)
* Disseminated Lyme disease
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours, typically divided as 2 grams every 12 hours.
* **Meningitis:** 2 grams IV every 24 hours, or 1 gram IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose. (1 gram for disseminated gonococcal infections).
* **Surgical prophylaxis:** 1-2 grams IV/IM 30-60 minutes before surgery.
Maximum daily dose is generally 4 grams.
## Pediatric Dosing
Dosing is weight-based and depends on the indication and severity. Consult institutional guidelines or specific pediatric infectious disease resources for precise dosing.
* **General:** 50-100 mg/kg/day IV/IM divided every 24 hours.
* **Severe infections/Meningitis:** 100 mg/kg/day IV divided every 12-24 hours.
* **Neonates (0-14 days):** 25-50 mg/kg/day IV divided every 24 hours. Avoid concurrent IV calcium-containing solutions.
* **Neonates (15-28 days) & Premature infants:** 50 mg/kg/day IV divided every 24 hours.
Maximum daily dose in children is generally 4 grams.
## Dose Adjustments
No dose adjustment is necessary for renal or hepatic impairment. However, caution and monitoring are advised in severe impairment, especially if combined.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (≤ 28 days of age) who are receiving or expected to receive intravenous calcium-containing solutions, including continuous IV infusions.
## Adverse Effects
* **Common:** Diarrhea, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludge/pseudolithiasis (especially in neonates), anaphylaxis, Stevens-Johnson syndrome, interstitial nephritis, hepatic dysfunction.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together, especially in severe renal impairment.
* **Warfarin:** Ceftriaxone may potentiate the effect of warfarin. Monitor INR.
* **Oral Contraceptives:** Ceftriaxone may decrease the efficacy of oral contraceptives. Advise backup contraception.
* **Calcium-containing solutions/products:** Contraindicated in neonates due to risk of precipitation in lungs and kidneys.
## Monitoring
* Signs and symptoms of infection (fever, elevated white blood cell count, localized signs).
* Renal and hepatic function (especially in severe impairment or prolonged therapy).
* Signs of hypersensitivity reactions.
* Monitor for diarrhea and assess for *C. difficile* infection.
* For neonates, monitor for signs of biliary precipitation.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in many indications.
* It is a common choice for empiric treatment of community-acquired pneumonia, meningitis, and skin/soft tissue infections.
* Due to its efficacy against *Neisseria gonorrhoeae*, it is the preferred agent for gonococcal infections.
* When administering IM, lidocaine may be used as the diluent to minimize pain, but should not be used in neonates.
* Do not mix or administer ceftriaxone simultaneously with calcium-containing solutions (including TPN) in the same IV line, regardless of age, due to potential for precipitation. Flush lines thoroughly between infusions.
---
***Disclaimer:*** *This information is intended for clinical professionals and is not a substitute for professional medical judgment. Always consult the official prescribing information and institutional protocols for complete and up-to-date guidance.*
