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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
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Complicated urinary tract infections
* Skin and soft tissue infections
* Meningitis (bacterial)
* Sepsis
* Disseminated gonococcal infections
* Pelvic inflammatory disease
* Typhoid fever
* Prophylaxis for surgical procedures
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 24 hours. Doses may be given every 12 hours for severe infections.
* **Meningitis:** 2 grams IV every 12 hours.
* **Disseminated gonococcal infection:** 1 gram IV/IM once daily for 7 days.
* **Surgical prophylaxis:** 1-2 grams IV within 60 minutes prior to incision.
* **Maximum dose:** 4 grams per day.
## Pediatric Dosing
Dosing is dependent on indication and weight. **Consult local guidelines or specific pediatric infectious disease protocols for exact dosing.**
* **General guideline:** 50-100 mg/kg/day IV/IM divided every 24 hours. For severe infections, may divide every 12 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
* **Neonates (0-14 days):** 25-50 mg/kg/day IV divided every 24 hours.
* **Maximum dose (pediatric):** Generally 2 grams per day, but higher doses may be used for severe infections like meningitis (e.g., up to 4 grams/day under strict guidance).
## Dose Adjustments
No dose adjustment is required for hepatic impairment or in patients with renal impairment. However, in severe renal impairment (creatinine clearance <10 mL/min), the daily dose should not exceed 2 grams unless higher doses are clinically indicated.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* **Neonates (<28 days):** Ceftriaxone should **not** be administered to neonates if they are receiving or expected to receive calcium-containing intravenous products, including continuous or intermittent infusions, due to the risk of precipitation of ceftriaxone-calcium in the lungs and kidneys.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:**
* *Clostridioides difficile*-associated diarrhea
* Biliary sludge or pseudolithiasis (especially in neonates and children)
* Hemolytic anemia
* Seizures (rare, usually with very high doses)
* Anaphylaxis
## Key Drug Interactions
* **Calcium-containing solutions:** Co-administration with calcium-containing solutions or products is contraindicated in neonates and should be avoided in other patients due to the risk of precipitation. Ensure adequate flushing of IV lines between administration.
* **Warfarin:** May decrease the effect of warfarin, leading to an increased risk of bleeding. Monitor INR closely.
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of *C. difficile*-associated diarrhea.
* Monitor for biliary sludge formation, particularly in neonates and children.
* Monitor renal and liver function, especially in patients with pre-existing impairment or receiving other nephrotoxic/hepatotoxic agents.
* Monitor INR if patient is on warfarin.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in many indications, which can improve adherence and reduce healthcare costs.
* Ensure adequate hydration and flushing of IV lines to prevent precipitation, especially when administered via central venous access.
* Because of its broad spectrum, it is often used empirically for serious infections. De-escalation should be considered once culture and sensitivity results are available.
* The risk of biliary precipitation is significant in neonates and children; while often asymptomatic, it can mimic serious pathology.
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*Disclaimer: This information is intended for educational purposes and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to ensure patient-specific appropriateness.*
