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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
* Pneumonia
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Sepsis
* Gonorrhea
* Lyme disease (early disseminated)
## Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 12 or 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Sepsis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM x 1 dose.
* **Disseminated Gonococcal Infections:** 1 gram IV/IM every 24 hours for 7 days.
* **Lyme Disease (Early Disseminated):** 2 grams IV every 24 hours for 14-21 days.
* **Maximum Daily Dose:** Typically 4 grams per day, though higher doses may be used in specific severe infections under specialist guidance.
## Pediatric Dosing
* **Neonate (< 7 days):** 25-50 mg/kg IV/IM every 24 hours.
* **Neonate (> 7 days) and Children:**
* **General Infections:** 50-100 mg/kg/day IV/IM divided every 12-24 hours.
* **Meningitis:** 80-100 mg/kg/day IV divided every 12 hours.
* **Maximum Daily Dose:** Generally 2 grams per day. Higher doses (up to 4 grams) may be considered for severe infections in older children, following local protocols or specialist recommendation.
## Dose Adjustments
No dose adjustment is necessary in patients with hepatic impairment. In severe renal impairment (CrCl < 10 mL/min), the daily dose may be halved, but this is not always necessary if adequate renal function is maintained.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 41 weeks postmenstrual age) receiving IV calcium-containing solutions or infusions due to risk of precipitation in pulmonary vasculature and kidneys.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site, eosinophilia, thrombocytosis.
* **Less Common:** Leukopenia, neutropenia, hemolytic anemia, biliary sludging or pseudolithiasis (especially in neonates), allergic reactions (including anaphylaxis), C. difficile-associated diarrhea.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with concurrent use in severe infections. Monitor renal function.
* **Warfarin:** May decrease warfarin's effect. Monitor INR closely and adjust warfarin dose as needed.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates. Potential for precipitation in adults if administered through the same IV line.
## Monitoring
* Renal and hepatic function, especially in patients with pre-existing impairment or receiving concurrent nephrotoxic agents.
* Signs and symptoms of infection resolution.
* Potential for adverse effects, including hypersensitivity reactions and C. difficile-associated diarrhea.
* For neonates, monitor for signs of precipitation.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in adults; however, lidocaine is often used to reduce injection site pain. Do not use lidocaine in neonates and infants.
* Reconstituted solutions for IM injection should not be diluted further. IV solutions can be further diluted.
* Ensure adequate time between administration of ceftriaxone and calcium-containing products when administered intravenously, particularly in adults.
* Biliary sludging is common and usually asymptomatic, resolving after drug discontinuation.
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*Please verify current prescribing information and local protocols for specific patient management.*
