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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
* Lower respiratory tract infections (e.g., community-acquired pneumonia, hospital-acquired pneumonia)
* Meningitis (bacterial)
* Bone and joint infections
* Intra-abdominal infections
* Skin and soft tissue infections
* Urinary tract infections, including pyelonephritis
* Sepsis
* Gonorrhea and its complications
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours, typically divided as 2 grams every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1-2 grams IV/IM given 30-60 minutes before incision.
* **Gonorrhea:** 500 mg IM (single dose); 1 gram IM for disseminated gonococcal infection.
* **Note:** Dosing may vary based on specific indication, severity of infection, and local protocols.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days):** 50 mg/kg IV every 24 hours.
* **Infants and Children (>28 days to 12 years):**
* **General Infections:** 50-100 mg/kg/day IV/IM divided every 12 or 24 hours.
* **Severe Infections/Meningitis:** Up to 100 mg/kg/day IV divided every 12 hours. Maximum daily dose is 4 grams.
* **Note:** Dosing in pediatric patients, especially neonates, requires careful consideration of weight and age due to potential risk of bilirubin displacement (kernicterus). IV administration is preferred in neonates.
## Dose Adjustments
No dose adjustment is generally required for adult patients with renal impairment. However, monitor closely for efficacy and toxicity. In severe hepatic impairment, dose adjustments may be considered, though data is limited.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 41 weeks postmenstrual age) receiving IV calcium-containing solutions or infusions, including continuous IV infusions with TPN, due to the risk of precipitation of ceftriaxone-calcium.
## Adverse Effects
Common: Diarrhea, rash, phlebitis (at injection site), eosinophilia, elevated liver enzymes.
Less Common: Nausea, vomiting, headache, dizziness, leukopenia, thrombocytopenia, renal changes, gallbladder sludging (especially with prolonged use or high doses).
Rare: Anaphylaxis, C. difficile-associated diarrhea, biliary pseudolithiasis, kernicterus in neonates.
## Key Drug Interactions
* **Calcium-containing Solutions (including TPN):** Do not mix or administer simultaneously via any route (IV or IM) due to the risk of precipitation. Separate administration by at least 48 hours.
* **Aminoglycosides:** Potential for additive nephrotoxicity, monitor renal function.
* **Warfarin:** Ceftriaxone may alter the effect of warfarin; monitor INR.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* Assess for signs and symptoms of infection.
* Monitor for adverse effects, particularly diarrhea and hypersensitivity reactions.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or those receiving other nephrotoxic/hepatotoxic agents.
* Monitor CBC, particularly with prolonged therapy.
* Monitor INR if patient is on warfarin.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing in many cases, improving patient compliance.
* Biliary pseudolithiasis (sludge) can occur and is usually asymptomatic and reversible upon discontinuation of the drug.
* Due to its metabolism and excretion, it is generally considered safe in renal impairment without dose adjustment for adults.
* It is a preferred agent for empiric treatment of community-acquired pneumonia and meningitis.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before administering any medication.
