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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
* Skin and skin structure infections
* Complicated urinary tract infections
* Pneumonia (community-acquired and hospital-acquired)
* Meningitis
* Sepsis
* Pelvic inflammatory disease
* Gonorrhea and other sexually transmitted infections
* Prophylaxis for surgical procedures
### Adult Dosing
* **General:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Severe Infections:** Doses up to 4 grams IV per day, divided every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. (For disseminated gonococcal infections, refer to specific guidelines).
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes before surgery.
### Pediatric Dosing
* **Neonates (< 7 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Infants and Children (> 7 days to 12 years):**
* **General:** 50-100 mg/kg/day IV or IM, divided every 12 or 24 hours.
* **Severe Infections:** Up to 150 mg/kg/day IV or IM, divided every 12 or 24 hours. Do not exceed 4 grams/day.
* **Children > 12 years:** Dosing as per adult recommendations.
* **Meningitis:** 100 mg/kg/day IV, divided every 12 hours. Maximum 4 grams/day.
### Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically required due to extensive hepatic elimination. However, in severe renal impairment, monitor closely and consider dose reduction if hepatic function is also compromised.
* **Hepatic Impairment:** No dose adjustment is typically required due to extensive renal excretion. However, in severe hepatic impairment, monitor closely and consider dose reduction if renal function is also compromised.
### Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* **Neonates (term and preterm):** IV administration is contraindicated in neonates receiving calcium-containing IV solutions or products, due to the risk of precipitation of ceftriaxone-calcium.
* **Hyperbilirubinemic neonates:** Ceftriaxone can displace bilirubin from albumin, potentially worsening hyperbilirubinemia.
### Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge or pseudolithiasis (especially in neonates), eosinophilia, leukopenia, thrombocytopenia, and rare instances of hemolytic anemia.
### Key Drug Interactions
* **Calcium-containing IV solutions/products:** Contraindicated in neonates (see Contraindications).
* **Probenecid:** May increase and prolong ceftriaxone serum levels.
* **Warfarin:** Ceftriaxone may potentially interfere with vitamin K synthesis, leading to an enhanced anticoagulant effect. Monitor INR closely.
### Monitoring
* Signs and symptoms of infection (fever, WBC count, clinical improvement).
* Signs of hypersensitivity reactions.
* Bowel function (for diarrhea).
* Liver function tests and renal function tests, especially with prolonged therapy or in patients with pre-existing organ dysfunction.
* Coagulation parameters if co-administered with warfarin.
### Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in children if lidocaine is unavailable or contraindicated, but this may increase injection site pain.
* For IM administration, reconstitute with the appropriate diluent (e.g., sterile water for injection, 1% lidocaine solution) as per manufacturer instructions.
* For IV administration, reconstitute with sterile water for injection or saline and further dilute in compatible IV fluid (e.g., D5W, NS). Administer as IV piggyback or bolus over 30 minutes.
* The extended half-life allows for once or twice-daily dosing.
* Biliary pseudolithiasis is a common, usually asymptomatic finding. If symptomatic, it typically resolves after discontinuation of the drug.
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*This information is intended for clinical use and is not a substitute for professional medical advice. Always consult current prescribing information and your institution's protocols for the most up-to-date and complete details.*
