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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
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Skin and skin structure infections
* Urinary tract infections
* Meningitis (bacterial)
* Gonococcal infections
* Sepsis
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Severe Infections/Meningitis:** Up to 4 grams IV every 24 hours, often given as 2 grams every 12 hours.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes prior to incision.
* **Uncomplicated Gonococcal Infections:** 500 mg IM as a single dose. (1 gram IM for disseminated gonococcal infection).
## Pediatric Dosing
Dosing is weight-based and depends on the indication. Specific protocols should be consulted.
* **General Infections:** 50-100 mg/kg/day IV or IM divided every 12 or 24 hours.
* **Severe Infections/Meningitis:** Up to 100 mg/kg/day IV divided every 12 or 24 hours. Maximum dose is typically 4 grams/day.
* **Neonates (0-14 days):** 25-50 mg/kg/day IV divided every 24 hours. *Note: Ceftriaxone is contraindicated in hyperbilirubinemic neonates, especially premature infants.*
## Dose Adjustments
No dose adjustment is generally required for renal or hepatic impairment. However, in severe renal impairment with concurrent hepatic impairment, the total daily dose may be reduced.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates with hyperbilirubinemia, especially premature infants, due to risk of kernicterus.
* Co-administration with IV calcium-containing solutions in neonates.
## Adverse Effects
Common: Diarrhea, rash, phlebitis, eosinophilia, thrombocytosis.
Less Common: Leukopenia, nausea, vomiting, abdominal pain, elevated liver enzymes, renal impairment.
Rare: Anaphylaxis, Stevens-Johnson syndrome, C. difficile-associated diarrhea, biliary sludging (pseudolithiasis).
## Key Drug Interactions
* **Calcium-containing solutions:** Avoid concurrent administration of IV ceftriaxone and IV calcium-containing solutions, especially in neonates. If necessary, separate administration by at least 48 hours.
* **Warfarin:** Ceftriaxone may potentiate the effect of warfarin. Monitor INR.
* **Aminoglycosides:** Potential for increased nephrotoxicity, although data is conflicting.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (especially in prolonged therapy or severe impairment).
* Complete blood count.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once or twice-daily dosing.
* Can be administered IM without lidocaine in adults (check local guidelines for pediatric use).
* Biliary sludging can occur, especially with prolonged or high-dose therapy; often asymptomatic.
* Cross-reactivity with penicillin allergies is possible but less common than with first-generation cephalosporins.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant institutional protocols before administering any medication.*
