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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
* Bacterial meningitis
* Community-acquired pneumonia
* Pneumonia acquired in healthcare settings
* Skin and skin structure infections
* Urinary tract infections
* Complicated intra-abdominal infections
* Septicemia
* Gonorrhea and its complications
* Pelvic inflammatory disease
* Prophylaxis for surgical infections
## Adult Dosing
* **General infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical prophylaxis:** 1 to 2 grams IV or IM given 30 to 60 minutes prior to incision.
* **Uncomplicated Gonorrhea:** 250 mg IM once.
* **Maximum dose:** 4 grams per day.
## Pediatric Dosing
Dosing is weight-based and depends on the indication and severity of infection. Specific protocols should be followed.
* **General infections (less than or equal to 12 years of age and less than 50 kg):** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours.
* **General infections (greater than 12 years of age or greater than 50 kg):** Refer to adult dosing.
* **Meningitis (neonates < 7 days):** 25 mg/kg IV every 24 hours.
* **Meningitis (neonates 7-14 days):** 50 mg/kg IV every 24 hours.
* **Meningitis (neonates > 14 days and adults):** 100 mg/kg/day IV divided every 12 hours.
* **Maximum pediatric dose:** 2 grams per day.
## Dose Adjustments
No dose adjustment is necessary for renal or hepatic impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than or equal to 28 days of age) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, phlebitis at injection site, rash, eosinophilia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (anaphylaxis), biliary sludging/cholelithiasis (especially in neonates and with prolonged use), hemolytic anemia, renal or hepatic dysfunction, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, particularly in patients with renal impairment.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin, leading to increased INR. Monitor INR closely.
* **Probenecid:** May prolong the elimination of ceftriaxone.
* **Calcium-containing solutions:** Contraindicated in neonates when co-administered IV.
## Monitoring
* **General:** Monitor for signs and symptoms of hypersensitivity, *C. difficile* infection, and allergic reactions.
* **Biliary effects:** Monitor for abdominal pain, jaundice, or signs of cholecystitis, especially in neonates and prolonged therapy. Ultrasound may be considered.
* **Renal and Hepatic Function:** Baseline and periodic monitoring may be considered in patients with pre-existing organ dysfunction or those receiving prolonged therapy.
## Clinical Pearls
* Ceftriaxone is highly protein-bound, which contributes to its long half-life and allows for once or twice-daily dosing.
* Due to the risk of precipitation, ceftriaxone should not be mixed or administered simultaneously with calcium-containing solutions. Separate administration lines are required.
* IM administration may be painful. Consider lidocaine for reconstitution if available and appropriate.
* Ceftriaxone is often a component of empiric antibiotic regimens for serious infections.
Please consult the most current prescribing information and institutional protocols for definitive guidance.
