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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 infections:** Pneumonia, skin and soft tissue infections, urinary tract infections, intra-abdominal infections, meningitis, gonorrhea, sepsis, bone and joint infections, and surgical prophylaxis.
* **Specific pathogens:** Effective against *Streptococcus pneumoniae*, *Haemophilus influenzae*, *Moraxella catarrhalis*, *Escherichia coli*, *Klebsiella* species, *Proteus* species, *Neisseria gonorrhoeae*, and *Neisseria meningitidis*. Less reliable against *Pseudomonas aeruginosa* and most enterococci.
## Adult Dosing
* **General infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours. For severe infections, doses may be increased to 4 grams IV per day, divided into two 2-gram doses every 12 hours.
* **Uncomplicated gonorrhea:** 250 mg IM as a single dose.
* **Surgical prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
* **Meningitis:** 2 grams IV every 12 hours.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours.
* **Neonates (15-28 days) and children < 50 kg:** 50-100 mg/kg/day IV or IM divided every 12-24 hours. Maximum 2 grams/day.
* **Children > 50 kg:** Dosing as per adult guidelines.
* **Meningitis (pediatric):** 100 mg/kg/day IV divided every 12 hours. Maximum 4 grams/day.
## Dose Adjustments
* **Renal impairment:** No dose adjustment is typically required due to high biliary excretion. However, in severe renal impairment and hepatic dysfunction, caution and monitoring may be warranted.
* **Hepatic impairment:** No dose adjustment is typically required.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates receiving calcium-containing intravenous solutions (risk of precipitation).
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludging (especially in neonates), anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatic dysfunction, renal dysfunction, and hemolytic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used concurrently, particularly in patients with renal impairment.
* **Warfarin:** Ceftriaxone may potentiate the effect of warfarin; monitor INR closely.
* **Probenecid:** Probenecid may increase ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates due to the risk of fatal precipitation in the lungs and kidneys.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of *C. difficile* infection.
* Monitor liver function tests and renal function tests periodically, especially with prolonged therapy or in patients with pre-existing organ dysfunction.
* Monitor for signs of biliary sludging, particularly in neonates.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in many indications.
* For intramuscular administration, reconstitute with the appropriate diluent (e.g., 1% lidocaine hydrochloride without epinephrine) to minimize injection site pain.
* When reconstituting for IV administration, use compatible diluents and administer promptly. Do not mix with other cephalosporins or other antibiotics.
* Ensure adequate hydration in patients to minimize the risk of crystalluria.
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*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making treatment decisions.*
