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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.
## Primary Indications
* Bacterial meningitis
* Pneumonia (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections, including pyelonephritis
* Intra-abdominal infections
* Sepsis
* Gonorrhea
* Lyme disease (early and late disseminated)
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe Infections (e.g., meningitis, sepsis):** 2 grams IV every 12 hours (total daily dose of 4 grams).
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes prior to incision.
* **Gonorrhea:** 500 mg IM as a single dose (1 gram IM for disseminated gonococcal infections).
* **Lyme Disease (early):** 1 gram IV or IM every 24 hours for 14-21 days.
* **Lyme Disease (late disseminated):** 1-2 grams IV every 24 hours for 14-21 days.
* **Maximum Daily Dose:** Generally 4 grams.
## Pediatric Dosing
Dosing is typically weight-based and depends on the indication and severity of infection. Local protocols should be consulted for precise dosing.
* **General Infections:** 50-100 mg/kg/day IV or IM divided every 12-24 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (maximum 4 grams/day). Some sources recommend up to 120 mg/kg/day divided every 8 hours for specific pathogens.
* **Neonates (0-14 days):** 25-50 mg/kg/day IV divided every 24 hours. Avoid in hyperbilirubinemic neonates.
* **Neonates (15-28 days):** 50 mg/kg/day IV divided every 24 hours.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically required in adults due to high biliary excretion. However, caution may be advised in severe renal impairment with concomitant hepatic dysfunction.
* **Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* **Neonates:** Ceftriaxone is contraindicated in neonates (especially premature) receiving concomitant calcium-containing IV solutions or infusions due to the risk of precipitate formation in the lungs and kidneys.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
Less Common/Serious: *Clostridioides difficile*-associated diarrhea, cholelithiasis (biliary pseudolithiasis), hemolytic anemia, anaphylaxis, seizures (rare).
## Key Drug Interactions
* **Calcium-Containing Solutions:** Concurrent administration with IV calcium-containing solutions in neonates can lead to fatal precipitates. Separate administration by at least 48 hours if both are necessary in adults, particularly those with renal impairment.
* **Aminoglycosides:** Potential for increased nephrotoxicity when used together, especially in severe infections. Monitor renal function.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* **Renal and Hepatic Function:** Especially in patients with pre-existing impairment or receiving other nephrotoxic/hepatotoxic agents.
* **Electrolytes:** Monitor if prolonged therapy or in specific populations.
* **Signs and Symptoms of Superinfection:** Monitor for *C. difficile*-associated diarrhea.
* **Therapeutic Response:** Clinical signs and symptoms of infection.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in most adult indications.
* IM administration is generally well-tolerated but may cause pain at the injection site.
* Ceftriaxone is a treatment of choice for disseminated gonococcal infections.
* In patients with renal failure, ceftriaxone's dependence on biliary excretion allows for continued effective dosing without reduction.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
