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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
* Pneumonia
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Sepsis
* Gonorrhea (disseminated and uncomplicated)
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 12 or 24 hours. Doses up to 4 grams IV per day have been used for severe infections.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infections, 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **General Infections:** 50-100 mg/kg/day IV/IM divided every 12 or 24 hours. Maximum daily dose is 4 grams.
* **Meningitis:** 100 mg/kg/day IV divided every 12 or 24 hours. Maximum daily dose is 4 grams.
* **Neonates (0-14 days):** 25-50 mg/kg/day IV/IM divided every 24 hours. Avoid in hyperbilirubinemic neonates.
## Dose Adjustments
No dose adjustment is required for renal or hepatic impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (birth to 28 days) receiving IV calcium-containing solutions due to risk of precipitation.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
Serious: *Clostridioides difficile*-associated diarrhea, biliary sludging, anaphylaxis, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, particularly in severe renal impairment.
* **Warfarin:** May alter INR; increased monitoring of INR is recommended.
* **Calcium-containing solutions:** Contraindicated in neonates due to precipitation risk.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function, especially in patients with underlying impairment or receiving other nephrotoxic agents.
* For neonates, monitor for signs of biliary sludging or precipitation.
## Clinical Pearls
* Ceftriaxone can be administered intramuscularly without lidocaine in children and adults.
* If treating gonorrhea and the patient has concurrent syphilis, co-treatment for syphilis is recommended as ceftriaxone may mask symptoms of syphilis.
* Due to its long half-life, once-daily dosing is often effective.
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**Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and institutional protocols before administering medications.
