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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
* Skin and skin structure infections
* Urinary tract infections
* Pelvic inflammatory disease
* Septicemia
* Gonorrhea
## Adult Dosing
* **General:** 1 to 2 grams (g) every 12 to 24 hours.
* **Severe infections:** Up to 4 grams (g) every 24 hours, administered in divided doses every 12 hours.
* **Meningitis:** 2 grams (g) every 12 hours.
* **Uncomplicated Gonorrhea:** 500 milligrams (mg) intramuscularly (IM) as a single dose.
* **Complicated Gonorrhea:** 1 gram (g) IM or IV every 24 hours for 7 days.
Maximum daily dose: 4 grams (g).
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg/day IV every 24 hours.
* **Neonates (15-28 days):** 50 mg/kg/day IV every 12 hours.
* **Pediatric Patients (> 15 days to 12 years or ≤ 50 kg):**
* **General:** 50-100 mg/kg/day IV or IM every 12 to 24 hours.
* **Severe infections:** Up to 120 mg/kg/day IV or IM every 12 hours.
* **Meningitis:** 100 mg/kg/day IV or IM every 12 hours.
* **Pediatric Patients (> 12 years or > 50 kg):** Use adult dosing.
Maximum pediatric dose: 4 grams (g) per day.
*Note: Dosing for neonates should not exceed 50 mg/kg/day due to the risk of kernicterus.*
## Dose Adjustments
No dose adjustment is necessary for hepatic or renal impairment when ceftriaxone is used as monotherapy. However, if both hepatic and renal function are severely impaired, the dose may need to be reduced. Follow local protocols for combined impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or any component of the formulation.
* Neonates (≤ 28 days old) receiving IV calcium-containing solutions or infusions due to the risk of precipitation in pulmonary and renal vasculature.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site, eosinophilia, thrombocytosis.
* **Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), biliary sludge/cholelithiasis, neutropenia, hemolytic anemia, renal failure.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with higher doses.
* **Warfarin:** May decrease the effect of warfarin, requiring closer INR monitoring.
* **Calcium-containing solutions/products (IV):** Contraindicated in neonates due to precipitation risk. Caution in adults; avoid co-administration through the same IV line. If co-administration is necessary, flush the line thoroughly between infusions.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function, especially in patients with pre-existing impairment or those receiving concomitant nephrotoxic agents.
* Complete blood count (CBC) if prolonged therapy is expected.
* Signs of hypersensitivity reactions.
* For neonates receiving IV calcium: Monitor for signs of precipitation.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in adults if lidocaine is unavailable, though it will be painful. Use preservative-free lidocaine for IM reconstitution if available.
* Due to its long half-life, ceftriaxone can often be dosed once daily.
* Biliary sludge formation is a common, often asymptomatic, finding. Management is typically supportive.
* Ceftriaxone is the preferred agent for disseminated gonococcal infection and for empiric treatment of community-acquired bacterial meningitis.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and relevant guidelines for complete details before making clinical decisions.*
