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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
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Intra-abdominal infections
* Bacterial meningitis
* Sepsis
* Gonorrhea and its complications
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe Infections:** Up to 4 grams IV daily, divided every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
* **Maximum Daily Dose:** 4 grams.
Dosing frequency and duration depend on the site and severity of infection, pathogen susceptibility, and clinical response.
## 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) and Infants/Children:**
* **General Infections:** 50-100 mg/kg/day IV or IM divided every 12 to 24 hours.
* **Severe Infections:** Up to 150 mg/kg/day IV or IM divided every 8 to 12 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
* **Maximum Daily Dose:** 2 grams in neonates; 4 grams in infants and children.
Actual pediatric dosing often relies on local institutional protocols and specific guidelines.
## Dose Adjustments
No dose adjustment is generally required for hepatic impairment. In severe renal impairment (CrCl < 10 mL/min), the daily dose may be halved. If both hepatic and renal function are severely impaired, doses should not exceed 2 grams daily.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Hyperbilirubinemic neonates (especially those receiving calcium-containing solutions).
## Adverse Effects
* **Common:** Diarrhea, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, cholelithiasis (biliary pseudolithiasis), hemolytic anemia, Stevens-Johnson syndrome, renal and hepatic dysfunction, Agranulocytosis.
## Key Drug Interactions
* **Calcium-containing solutions:** Avoid concurrent administration in neonates due to risk of precipitation in lungs and kidneys. In adults, separate administration by at least 48 hours or flush line with a compatible diluent.
* **Warfarin:** May decrease INR; monitor INR closely.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count.
* Prothrombin time/INR if patient is on anticoagulants or has impaired vitamin K synthesis.
* For neonates, monitor bilirubin levels and signs of precipitation.
## Clinical Pearls
* Ceftriaxone is a common choice for empiric treatment of serious bacterial infections.
* Reconstituted solutions have limited stability; refer to manufacturer guidelines for storage.
* IM injections are painful; consider lidocaine as a diluent for IM administration (ensure appropriate concentration and volume).
* Risk of cholelithiasis (biliary pseudolithiasis) can occur with prolonged use; may manifest as biliary colic.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
