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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
* Pneumonia
* Meningitis
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Gonorrhea (disseminated and uncomplicated)
* Pelvic inflammatory disease
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours, often divided into two 2-gram doses every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 250 mg IM once.
* **Disseminated Gonorrhea:** 1 gram IV or IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30 to 120 minutes before surgical incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV once daily. Do not exceed 125 mg/day.
* **Neonates (15-28 days):** 50 mg/kg IV once daily.
* **Infants and Children (>28 days to 12 years):**
* **General Infections:** 50-100 mg/kg/day IV or IM divided every 12-24 hours.
* **Severe Infections:** Up to 100 mg/kg/day IV, not to exceed 4 grams/day, divided every 12 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
* **Children >12 years:** Adult dosing.
Dosing for specific conditions, especially in neonates, may be guided by local protocols.
## Dose Adjustments
No dose adjustment is typically required for renal impairment. Ceftriaxone is primarily eliminated by the kidneys and hepatobiliary system.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 41 weeks post-conceptional age) receiving IV calcium-containing solutions or infusions concurrently with ceftriaxone due to the risk of precipitation in the lungs and kidneys.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis at the injection site, eosinophilia, thrombocytosis.
* **Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, seizures (rare), biliary sludge or pseudolithiasis (especially in children), hemolytic anemia.
## Key Drug Interactions
* **Calcium-containing solutions:** Avoid coadministration (IV or infusions) in neonates. In adults, separate administration by at least 48 hours if coadministration is necessary.
* **Warfarin:** May decrease the effectiveness of warfarin; monitor INR.
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together, although some studies suggest a synergistic effect in certain infections.
* **Probenecid:** May increase and prolong ceftriaxone levels.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (baseline and periodically if clinically indicated).
* Complete blood count (CBC) if prolonged therapy.
* INR if patient is on warfarin.
* Signs of hypersensitivity reactions.
* Biliary sludge may be monitored with ultrasound if symptoms arise.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing in most indications.
* Reconstitution with lidocaine for IM injection can reduce pain. Do not use lidocaine for IV administration.
* The risk of biliary pseudolithiasis is higher in neonates and pediatric patients. While often asymptomatic, it can mimic cholelithiasis.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.*
