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## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative organisms.
## Primary Indications
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Acute bacterial meningitis
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Complicated urinary tract infections
* Skin and soft tissue infections
* Bacterial sepsis
* Prophylaxis for surgical infections
## Adult Dosing
* **General:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Serious infections:** Up to 4 grams IV every 24 hours (divided into two doses of 2 grams each).
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Surgical prophylaxis:** 1 to 2 grams IV 30 to 60 minutes prior to incision.
Dosing and duration should be guided by the specific infection, severity, and clinical response, as per local protocols.
## Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg IV every 24 hours. Maximum 50 mg/kg/day.
* **Neonates (15-28 days), Infants, and Children:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours. Maximum 2 grams/day.
* **Severe infections (e.g., meningitis):** Up to 100 mg/kg/day IV divided every 12 to 24 hours. Maximum 4 grams/day.
Note: Ceftriaxone is contraindicated in hyperbilirubinemic neonates, particularly those born prematurely, due to the risk of kernicterus.
## Dose Adjustments
No dose adjustment is necessary for hepatic impairment. In severe renal impairment (CrCl < 10 mL/min), the daily dose can be halved, but this is often unnecessary due to biliary excretion.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates with hyperbilirubinemia.
## Adverse Effects
Common: Diarrhea, rash, phlebitis at the injection site, eosinophilia, thrombocytosis.
Serious: Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge or pseudolithiasis (especially in pediatrics), neutropenia, hemolytic anemia, renal dysfunction.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may decrease the effectiveness of warfarin. Monitor INR closely.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (baseline and periodically, especially in severe dysfunction or prolonged therapy).
* Complete blood count (CBC) with differential and platelets.
* Prothrombin time (PT)/International Normalized Ratio (INR) if patient is on anticoagulants.
* Injection site for signs of phlebitis.
## Clinical Pearls
* Ceftriaxone is poorly excreted by the kidneys, making it a good option for patients with renal insufficiency.
* Biliary precipitation (pseudolithiasis) is a known complication, particularly in children. This is usually asymptomatic and resolves after discontinuation.
* Do not mix ceftriaxone with calcium-containing solutions or diluents, including TPN, due to the risk of precipitation. Separate administration is required.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for the most accurate and up-to-date recommendations.
