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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
* Bacterial meningitis
* Community-acquired pneumonia
* Skin and soft tissue infections
* Urinary tract infections (including pyelonephritis)
* Intra-abdominal infections
* Sepsis
* Gonorrhea and disseminated gonococcal infections
* Prophylaxis for surgical site infections
## 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 single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes prior to incision.
Maximum daily dose for adults is generally 4 grams.
## Pediatric Dosing
Dosing in pediatric patients varies significantly by indication and age. Local institutional protocols should be consulted. General guidelines:
* **Neonate (<7 days):** 25-50 mg/kg IV every 24 hours.
* **Neonate (7-28 days, weight <2000g):** 25 mg/kg IV every 24 hours.
* **Neonate (7-28 days, weight >2000g):** 50 mg/kg IV every 24 hours.
* **Pediatric Patients (>28 days):** 50-100 mg/kg/day IV/IM, divided every 12-24 hours.
* **Severe Infections/Meningitis:** Up to 100 mg/kg/day IV, divided every 12 hours. Maximum daily dose is 4 grams.
**Note:** Due to the risk of kernicterus, ceftriaxone should not be administered to hyperbilirubinemic neonates, especially those less than 28 days old, or to neonates receiving calcium-containing solutions.
## Dose Adjustments
No dose adjustment is typically required for renal impairment or hepatic impairment due to extensive hepatic and biliary excretion. However, caution and monitoring are advised in severe renal or hepatic dysfunction.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 28 days old) receiving concomitant intravenous calcium-containing solutions due to risk of precipitates.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, phlebitis at injection site, rash, eosinophilia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludge/cholelithiasis (especially in neonates and prolonged therapy), hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, hematologic abnormalities (thrombocytopenia, leukopenia, hemolytic anemia), renal precipitation.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity. Monitor renal function closely.
* **Warfarin:** Ceftriaxone may decrease vitamin K production, potentially increasing the effect of warfarin. Monitor INR closely and consider vitamin K supplementation if necessary.
* **Probenecid:** May increase ceftriaxone serum concentrations.
* **Calcium-Containing Solutions:** Contraindicated in neonates due to risk of fatal precipitation in lungs and kidneys. Do not mix or administer concurrently in IV lines.
## Monitoring
* **Clinical:** Signs and symptoms of infection, response to therapy.
* **Laboratory:** Renal function (BUN, creatinine), liver function tests, complete blood count (especially with prolonged therapy), INR (if on warfarin).
* **Biliary:** Consider ultrasound for patients on prolonged therapy or those with risk factors for biliary sludge.
## Clinical Pearls
* Ceftriaxone is highly protein-bound.
* It is eliminated primarily by the liver and kidneys, making dose adjustments generally unnecessary in isolated renal or hepatic insufficiency.
* For intramuscular (IM) administration, reconstitute with 1% lidocaine HCl to minimize pain. Do not administer IM lidocaine solutions IV.
* The risk of biliary precipitation is higher in neonates and with higher doses or longer durations of therapy.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information or a qualified healthcare provider for any questions regarding a medical condition or treatment. Verify current prescribing information for Ceftriaxone before use.*
