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# Cefriaxone
## Overview
Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic with high activity against many Gram-positive and Gram-negative bacteria. It has a long half-life, allowing for once or twice daily dosing.
## Primary Indications
* **Infections:** Respiratory tract, skin and soft tissue, urinary tract, bone and joint, intra-abdominal, meningitis, gonorrhea, Lyme disease (early and late stage), surgical prophylaxis.
* **Bacteremia/Sepsis**
## Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 24 hours. In severe infections, doses up to 4 grams IV daily can be administered, usually divided every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Lyme Disease:** 2 grams IV daily for 14-30 days.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose.
* **Disseminated Gonococcal Infection:** 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days):** 50 mg/kg IV every 24 hours.
* **Infants and Children (>28 days):** 50-100 mg/kg IV/IM daily, divided every 12-24 hours. Maximum daily dose is 4 grams.
* **Meningitis:** 100 mg/kg IV daily, divided every 12 hours. Maximum daily dose is 4 grams.
* **Note:** Specific dosing for neonates may be subject to local protocols due to potential bilirubin displacement.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed if hepatic function is adequate.
* **Hepatic Impairment:** No dose adjustment is typically needed if renal function is adequate.
* **Combined Renal and Hepatic Impairment:** Dose reduction may be considered; consult specific guidelines.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 41 weeks post-conceptual age) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis (at IV site), eosinophilia, thrombocytosis, leukopenia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, Stevens-Johnson syndrome, hepatotoxicity, cholelithiasis (biliary sludge), hemolytic anemia, renal impairment, and central nervous system effects (rare).
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity (monitor renal function).
* **Warfarin:** May alter INR (monitor INR closely).
* **Probenecid:** Can increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates (risk of precipitation in lungs and kidneys). Ensure adequate flushing between infusions if co-administered in adults.
## Monitoring
* Signs and symptoms of infection (fever, WBC count, etc.).
* Renal and hepatic function.
* Prothrombin time/INR if patient is on anticoagulants or has impaired vitamin K synthesis.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine for reconstitution, but lidocaine may be used to reduce injection site pain.
* Biliary sludge (pseudolithiasis) is a common, usually reversible, side effect, especially in pediatric patients and with higher doses. Discontinuation is typically not required unless symptomatic.
* Ensure adequate hydration to minimize the risk of crystalluria.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local institutional protocols before initiating or modifying drug therapy.
