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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.
## Primary Indications
* Pneumonia
* Skin and skin structure infections
* Urinary tract infections
* Bacterial meningitis (including Neisseria meningitidis)
* Sepsis
* Gonorrhea
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams (g) intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe Infections:** Up to 4 grams (g) IV every 24 hours.
* **Surgical Prophylaxis:** 1 to 2 grams (g) IV 30-60 minutes prior to incision.
* **Uncomplicated Gonorrhea:** 500 milligrams (mg) IM single dose.
* **Complicated Gonorrhea/Pharyngeal Gonorrhea:** 1 gram (g) IM single dose.
* **Meningitis:** 2 grams (g) IV every 12 hours.
Dosing frequency and duration are dependent on the type and severity of infection, and specific clinical guidelines or local protocols should be consulted.
## 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, if low birth weight):** 25-50 mg/kg IV every 24 hours.
* **Pediatric Patients (15 days to 12 years):**
* **Uncomplicated Infections:** 50-75 mg/kg IV or IM every 24 hours.
* **Severe Infections:** 80-100 mg/kg IV every 24 hours.
* **Meningitis:** 100 mg/kg IV every 12 to 24 hours (max 4 g/day).
* **Pediatric Patients (over 12 years):** Dosing is generally the same as adults.
Maximum daily dose in children generally should not exceed the adult maximum of 4 grams/day, except in specific indications like meningitis where higher doses may be used per guidelines.
## Dose Adjustments
No dose adjustment is typically required for impaired renal function. However, dose adjustment may be considered in severe hepatic impairment, especially if combined with renal impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 28 days gestation and/or post-conceptional age) receiving IV ceftriaxone with concurrent use of calcium-containing solutions or products administered IV.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, injection site reactions.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea (CDAD), pseudolithiasis (biliary sludge), hemolytic anemia, eosinophilia, thrombocytosis, leukopenia, biliary concretions.
## Key Drug Interactions
* **Calcium-containing solutions/products:** Concomitant IV administration is contraindicated in neonates due to the risk of precipitation in pulmonary and renal vasculature. In adults, caution is advised; separate administration by at least 48 hours if both are administered IV.
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** May alter the effectiveness of warfarin; monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of CDAD.
* Monitor renal and hepatic function periodically, especially with prolonged therapy or in patients with pre-existing organ dysfunction.
* Monitor for signs of superinfection.
* In neonates, monitor for signs of biliary sludge or precipitation.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing in many cases.
* It can be administered IM without lidocaine, though lidocaine can reduce injection pain.
* Ceftriaxone is NOT a first-line agent for empiric treatment of methicillin-susceptible *Staphylococcus aureus* (MSSA) in serious infections due to potential resistance.
* Ceftriaxone is a common choice for empiric treatment of community-acquired pneumonia and meningitis in both pediatric and adult populations.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for the most up-to-date and complete drug information.
