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## Cefriaxone
### 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
* Skin and soft tissue infections
* Urinary tract infections
* Gonorrhea and other sexually transmitted infections
* Sepsis
* Bone and joint infections
* Prophylaxis in certain surgical procedures
### Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 12 or 24 hours.
* **Severe Infections:** Up to 4 grams IV per day, divided every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV within 60 minutes prior to incision.
### Pediatric Dosing
* **Non-Meningitis Infections:** 50-100 mg/kg/day IV/IM divided every 12-24 hours. Maximum daily dose is 4 grams.
* **Meningitis:** 100 mg/kg/day IV divided every 12-24 hours. Maximum daily dose is 4 grams.
* **Neonates (0-14 days):** 25-50 mg/kg/day IV divided every 24 hours. **Do not exceed 50 mg/kg/day.**
* **Neonates (15-28 days) and Infants:** Follow non-meningitis or meningitis dosing as above.
### Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally needed as ceftriaxone is extensively eliminated by the liver and excreted in bile. However, in severe renal impairment, monitoring may be considered.
* **Hepatic Impairment:** No dose adjustment is generally needed.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Concurrent use of IV calcium-containing solutions in neonates (risk of precipitation).
### Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, elevated liver enzymes.
* **Serious:** Severe allergic reactions (anaphylaxis), Clostridioides difficile-associated diarrhea, biliary sludge/pseudolithiasis, hemolytic anemia (especially in neonates), renal impairment, neurological effects (rare).
### Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity, particularly in patients with renal dysfunction.
* **Warfarin:** Ceftriaxone may alter the effect of warfarin; monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of potentially fatal precipitation in lungs and kidneys.
### Monitoring
* Monitor for signs of hypersensitivity reactions.
* Monitor for diarrhea and signs of C. difficile infection.
* Monitor liver function tests and renal function, especially with prolonged therapy or in patients with risk factors.
* Monitor INR if the patient is on warfarin.
### Clinical Pearls
* Ceftriaxone is a common choice for community-acquired pneumonia, bacterial meningitis, and gonorrhea.
* Intramuscular administration may be painful; consider lidocaine as a diluent (check local guidelines).
* Biliary sludge formation is more common with higher doses and prolonged therapy but is typically asymptomatic and resolves after discontinuation.
* Dosing frequency is often every 24 hours for many indications due to its long half-life.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before making clinical decisions.*
