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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Pneumonia
* Meningitis
* Skin and skin structure infections
* Urinary tract infections
* Pelvic inflammatory disease
* Bacterial meningitis (including *Neisseria meningitidis*)
* Prophylaxis for surgical procedures
* Disseminated gonococcal infections
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1 to 2 grams IV or IM given 30-120 minutes before surgery.
* **Disseminated Gonococcal Infection:** 1 gram IM or IV once. For pharyngeal gonorrhea, 500 mg IM once.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV or IM every 24 hours. Avoid IV administration with calcium-containing solutions.
* **Neonates (15-28 days):** 50 mg/kg IV or IM every 24 hours. Avoid IV administration with calcium-containing solutions.
* **Infants and Children (>28 days and <12 years or <50 kg):** 50-100 mg/kg/day IV or IM divided every 12-24 hours. Maximum daily dose is 2 grams.
* **Children (>12 years or >50 kg):** Dosing as per adult guidelines.
* **Bacterial Meningitis (Pediatric):** 100 mg/kg/day IV divided every 12 hours, not to exceed 4 grams daily. Duration is typically 7-21 days depending on the pathogen.
## Dose Adjustments
No dose adjustment is typically required for hepatic impairment. For severe hepatic and renal impairment, the total daily dose may be reduced if the patient weighs less than 50 kg.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving IV calcium-containing solutions. Ceftriaxone can precipitate with calcium in the blood and lungs, potentially leading to fatal outcomes.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at the injection site.
* **Less Common:** Headache, dizziness, eosinophilia, leukopenia, thrombocytopenia, thrombocytosis, elevated liver enzymes, glycosuria, hematuria, renal calculus, biliary sludge, jaundice.
* **Rare but Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, Stevens-Johnson syndrome, hepatic precipitation, hyperbilirubinemia in neonates.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with higher doses or prolonged use.
* **Warfarin:** Ceftriaxone may alter the anticoagulant effects of warfarin. Monitor INR closely.
* **Calcium-containing solutions (IV):** Contraindicated in neonates. Potential for fatal precipitation.
* **Probenecid:** May increase and prolong ceftriaxone levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea, particularly *C. difficile*-associated diarrhea.
* Monitor liver function tests (LFTs) and renal function tests (RFTs) periodically, especially with prolonged therapy.
* In neonates, monitor bilirubin levels.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing.
* It is highly protein-bound, which contributes to its long half-life and may influence dosing in specific populations.
* Reconstituted solutions are stable for specific timeframes at room temperature or refrigerated. Refer to manufacturer labeling for reconstitution and storage information.
* For IM administration, lidocaine can be used as a diluent to minimize injection site pain.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for the most up-to-date and complete details before making any treatment decisions.*
