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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
* Pneumonia (community-acquired, hospital-acquired)
* Meningitis
* Sepsis
* Urinary tract infections (complicated)
* Skin and soft tissue infections
* Gonorrhea (uncomplicated)
* Lyme disease
* Surgical prophylaxis
### Adult Dosing
* **General:** 1-2 grams IV/IM every 12-24 hours.
* **Severe infections/Meningitis:** Up to 4 grams IV daily, divided every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM once.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
### Pediatric Dosing
* **Neonate (< 28 days):** 25-50 mg/kg IV/IM every 24 hours. Avoid in hyperbilirubinemic neonates due to risk of kernicterus.
* **Infants and Children (> 28 days):**
* **General:** 50-100 mg/kg/day IV/IM, divided every 12-24 hours.
* **Meningitis:** 100 mg/kg/day IV, divided every 12 hours. Maximum 4 grams/day.
### Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed when renal and hepatic function are both impaired. In severe renal impairment (CrCl < 10 mL/min) without hepatic impairment, the usual dose may be halved.
* **Hepatic Impairment:** No dose adjustment is typically needed.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (birth to 28 days) receiving IV calcium-containing solutions or infusions.
### Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, injection site reactions (pain, phlebitis).
* **Serious:** *Clostridioides difficile*-associated diarrhea, Stevens-Johnson syndrome, anaphylaxis, hemolytic anemia, biliary sludge/pseudolithiasis (especially in neonates and prolonged therapy), pancreatitis.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity and ototoxicity.
* **Warfarin:** May alter INR; increased monitoring required.
* **Calcium-containing solutions:** Contraindicated for IV coadministration in neonates due to risk of fatal precipitation in the lungs and kidneys. In adults, separate administration by at least 48 hours or flush line thoroughly between infusions.
* **Probenecid:** May increase and prolong ceftriaxone levels.
### Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea, especially if severe or persistent, to rule out *C. difficile*.
* Monitor renal and hepatic function with prolonged therapy or in patients with pre-existing impairment.
* Monitor INR in patients taking warfarin.
* Monitor for signs of biliary sludge or pseudolithiasis, particularly in neonates and with prolonged therapy.
### Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice daily dosing.
* It is often a preferred agent for empiric treatment of community-acquired pneumonia, meningitis, and sepsis.
* Due to its long half-life and potential for biliary excretion, it is not the preferred agent for severe renal impairment if another suitable alternative exists.
* Reconstituted solutions should be used within specified timeframes (e.g., 24 hours at room temperature, 3 days refrigerated).
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional protocols for complete details and to verify dosages and recommendations before administration.*
