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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 via intramuscular (IM) or intravenous (IV) routes.
## Primary Indications
* Bacterial meningitis
* Pneumonia (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections, including pyelonephritis
* Intra-abdominal infections
* Gonorrhea (uncomplicated)
* Septicemia
* Prophylaxis for surgical procedures
## Adult Dosing
* **General Infections:** 1 to 2 grams (g) IV or IM every 12 to 24 hours. The maximum dose is typically 4 grams (g) per day.
* **Meningitis:** 2 grams (g) IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 milligrams (mg) IM single dose. For disseminated gonococcal infection, 1 g IV or IM every 24 hours for 7 days.
Dosing frequency and duration depend on the type and severity of infection, and the infecting organism.
## Pediatric Dosing
* **Newborns (0-14 days):** 25-50 mg/kg IV or IM every 24 hours. Maximum dose not to exceed 50 mg/kg/day. Avoid concomitant use with IV calcium-containing solutions.
* **Infants and Children (>14 days):**
* **General Infections:** 50-100 mg/kg IV or IM every 12 to 24 hours.
* **Meningitis:** 100 mg/kg IV every 12 hours (maximum 4 g/day).
Dosing in neonates requires careful consideration of gestational and postnatal age due to immature hepatic and renal function.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally needed in adults with impaired renal function, as ceftriaxone is primarily eliminated by the liver and bile. However, in patients with severe renal impairment and hepatic dysfunction, the total daily dose should not exceed 2 grams (g).
* **Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 28 days of age) receiving IV calcium-containing solutions or undergoing infusions containing calcium due to the risk of precipitation of ceftriaxone-calcium.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, phlebitis at the injection site.
* **Serious:** Anaphylaxis, C. difficile-associated diarrhea, biliary sludge or pseudolithiasis (especially in children), hematologic abnormalities (eosinophilia, leukopenia, thrombocytopenia), renal and hepatic abnormalities.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity, although not definitively established with ceftriaxone.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR closely.
* **Probenecid:** May increase ceftriaxone levels, but usually not clinically significant.
* **Calcium-containing solutions/products:** Contraindicated for IV co-administration, especially in neonates.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile infection.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing organ dysfunction.
* In neonates, monitor for signs of biliary precipitation.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice daily dosing.
* IM injection is often preferred for outpatient use when IV access is difficult. Lidocaine can be used as a diluent for IM injections to reduce pain.
* Ceftriaxone crosses the blood-brain barrier and is a preferred agent for bacterial meningitis.
* The risk of biliary pseudolithiasis in children can be reduced by ensuring adequate hydration and avoiding very rapid infusion.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.*
