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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)
* Meningitis (bacterial)
* Bone and joint infections
* Intra-abdominal infections
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Gonorrhea
* Septicemia
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams every 12 to 24 hours.
* **Severe infections:** Up to 4 grams daily.
* **Meningitis:** 2 grams every 12 hours.
* **Surgical prophylaxis:** 1 to 2 grams given 30 to 120 minutes before surgery.
* **Gonorrhea:** 500 mg IM once. For disseminated gonococcal infection, 1 gram IV/IM every 24 hours for 7 days.
Maximum daily dose: 4 grams.
## Pediatric Dosing
Dosing varies significantly based on indication and age. Local guidelines or specific protocols should be consulted.
* **General pediatric infections (≥ 1 month):** 50 to 100 mg/kg/day IV/IM divided every 12 to 24 hours.
* **Severe pediatric infections (≥ 1 month):** Up to 100 to 150 mg/kg/day IV/IM divided every 12 to 24 hours.
* **Meningitis (≥ 1 month):** 100 mg/kg/day IV divided every 12 hours, or 80 to 100 mg/kg/day IV divided every 24 hours. Maximum 4 grams daily.
* **Neonates (0-28 days):** 25 to 50 mg/kg/day IV divided every 24 hours. *Note: Avoid concurrent IV calcium administration in neonates due to risk of precipitation.*
* **Gonorrhea (pediatric patients and neonates):** 125 mg IM once.
Maximum daily dose in pediatrics: 4 grams.
## Dose Adjustments
No dose adjustment is required for renal or hepatic impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates (≤ 28 days) who require treatment for hyperbilirubinemia or are receiving IV calcium-containing solutions.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site.
* **Serious:** Clostridioides difficile-associated diarrhea, hypersensitivity reactions (anaphylaxis), eosinophilia, thrombocytosis, leukopenia, biliary sludge/cholelithiasis (especially in neonates and children).
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity; monitor renal function.
* **Warfarin:** May decrease the effect of warfarin; monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated for IV coadministration with ceftriaxone in neonates and should be avoided in all patients if possible due to risk of precipitation.
## Monitoring
* Assess for signs and symptoms of hypersensitivity.
* Monitor for diarrhea and signs of C. difficile infection.
* Monitor for biliary sludge or gallstones, particularly with prolonged therapy or in neonates/children.
* Monitor renal and hepatic function if clinically indicated.
## Clinical Pearls
* Ceftriaxone can be administered intramuscularly without lidocaine if necessary, though it may be painful.
* The long half-life allows for once or twice-daily dosing in most adult indications.
* Due to its high biliary excretion, ceftriaxone is generally *not* the preferred agent for urinary tract infections where urine concentration is critical unless other agents are unsuitable.
* Always reconstitute and dilute according to manufacturer instructions.
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*This information is intended for clinical pharmacists and healthcare professionals. Always verify current prescribing information and local protocols before administration.*
