Cefriaxone%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252528ceftriaxone%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252529

# 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 (including *Neisseria meningitidis*, *Haemophilus influenzae*, *Streptococcus pneumoniae*) * Pneumonia (community-acquired and hospital-acquired) * Skin and skin structure infections * Urinary tract infections (including pyelonephritis) * Pelvic inflammatory disease * Gonorrhea (disseminated and uncomplicated) * Sepsis * Bone and joint infections * Prophylaxis for surgical infections ## Adult Dosing * **General Infections:** 1-2 grams IV/IM every 12 or 24 hours. * **Severe Infections:** Up to 4 grams IV per day, divided every 12 hours. * **Meningitis:** 2 grams IV every 12 hours. * **Uncomplicated Gonorrhea:** 500 mg IM single dose. * **Disseminated Gonorrhea:** 1 gram IV/IM every 24 hours for 7 days. * **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes prior to incision. Maximum daily dose in adults is typically 4 grams. ## Pediatric Dosing * **Neonates (<7 days):** 25-50 mg/kg IV every 24 hours. * **Neonates (>7 days) and Children (<12 years):** 50-100 mg/kg/day IV/IM divided every 12-24 hours. * **Severe Infections (Children):** Up to 150 mg/kg/day IV divided every 8 hours. * **Meningitis (Children):** 100 mg/kg/day IV divided every 12-24 hours. Maximum daily dose in children is typically 4 grams. *Note: Intravenous administration is generally preferred in neonates to avoid complications associated with IM injection and potential hyperbilirubinemia.* ## Dose Adjustments * **Renal Impairment:** No dose adjustment is typically required for renal impairment unless severe. In cases of severe renal impairment, the dose may need to be reduced, or the dosing interval extended, though this is less common with ceftriaxone compared to other beta-lactams. * **Hepatic Impairment:** No dose adjustment is typically required. ## Contraindications * Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins. * Neonates (≤28 days) receiving concurrent IV calcium-containing solutions or infusions due to the risk of precipitation. ## Adverse Effects * **Common:** Diarrhea, nausea, vomiting, rash, thrombocytosis, eosinophilia. * **Less Common:** Leukopenia, thrombocytopenia, elevated liver enzymes, phlebitis at injection site, injection site pain. * **Rare but Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), Stevens-Johnson syndrome, anaphylaxis, biliary pseudolithiasis (especially in neonates). ## Key Drug Interactions * **Probenecid:** May increase and prolong ceftriaxone serum concentrations. * **Aminoglycosides:** Potential for additive nephrotoxicity; monitor renal function closely. * **Warfarin:** May alter the anticoagulant effect of warfarin; monitor INR. * **Calcium-containing Solutions/Products:** Contraindicated in neonates (≤28 days) due to risk of precipitation. Caution advised in other patient populations. ## Monitoring * Signs and symptoms of infection (fever, elevated white blood cell count, localized signs). * Renal and hepatic function, especially in patients with pre-existing impairment or receiving other nephrotoxic/hepatotoxic agents. * Electrolyte balance. * Signs of hypersensitivity reactions. * Bowel function for *C. difficile* infection. ## Clinical Pearls * Ceftriaxone has a long half-life, allowing for once or twice-daily dosing. * It is a good choice for empiric treatment of meningitis and community-acquired pneumonia. * Can be administered IM without lidocaine for reconstitution, but lidocaine may be used for IM injections to reduce pain. Use of lidocaine is not recommended for IV administration. * Biliary sludging can occur, particularly in neonates and children, and may be asymptomatic or mimic cholecystitis. If symptomatic, treatment may need to be discontinued. * Use with caution in patients with a history of gastrointestinal disease, especially colitis. *** *Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult the most current prescribing information and relevant clinical guidelines for definitive dosing and management decisions.*