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# Cefriaxone
## 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 soft tissue infections
* Urinary tract infections
* Sepsis
* Gonorrhea
* Prophylaxis for surgical infections
## Adult Dosing
* **General infections:** 1 to 2 grams IV/IM every 12 to 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Gonorrhea:** 500 mg IM as a single dose (1 gram for disseminated infections).
Dosing frequency and duration depend on the site and severity of infection, pathogen susceptibility, and patient response.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours.
* **Neonates (15-28 days):** 25-50 mg/kg IV every 12-24 hours.
* **Infants and Children (>28 days):** 50-100 mg/kg/day divided into 1 or 2 doses (IV/IM).
* **Severe infections/Meningitis:** Up to 100 mg/kg/day (maximum 4 grams/day) divided into 2 to 3 doses.
Note: Dosing in neonates should not exceed 50 mg/kg due to the risk of kernicterus.
## Dose Adjustments
No dose adjustment is typically required for renal impairment. However, if hepatic and renal function are both severely impaired, the total daily dose may be reduced.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (birth to 28 days) receiving IV calcium-containing solutions or infusions due to the risk of ceftriaxone-calcium precipitation in the lungs and kidneys.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, injection site reactions (pain, phlebitis).
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (anaphylaxis), cholelithiasis (biliary sludge), eosinophilia, thrombocytosis, leukopenia.
## Key Drug Interactions
* **Calcium-containing solutions:** Contraindicated in neonates. Avoid concurrent administration in adults, especially via IV route. If co-administration is necessary, administer sequentially and flush lines.
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may affect prothrombin time. Monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone levels.
## Monitoring
* Signs and symptoms of infection.
* Renal and liver function tests.
* Complete blood count.
* Prothrombin time/INR if on warfarin or with risk factors.
* Monitor for adverse effects, including diarrhea and rash.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in children, though it may cause pain.
* Due to its long half-life, it is often dosed every 12 or 24 hours.
* It is a common choice for empiric treatment of meningitis in many settings.
* Biliary sludge formation is a known side effect; consider monitoring for symptoms if prolonged therapy or in specific populations.
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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.*
