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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
* Pneumonia
* Meningitis (bacterial)
* Gonorrhea and Chlamydia infections
* Skin and soft tissue infections
* Bone and joint infections
* Sepsis
* Urinary tract infections
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours, often divided as 2 grams every 12 hours.
* **Uncomplicated Gonorrhea:** A single 250 mg IM dose.
* **Disseminated Gonococcal Infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25 mg/kg IV or IM every 24 hours. Do not exceed 125 mg.
* **Neonates (15-28 days):** 50 mg/kg IV or IM every 24 hours. Do not exceed 2 grams.
* **Older Children:**
* **General Infections:** 50 to 100 mg/kg/day IV or IM, divided every 12 or 24 hours.
* **Severe Infections/Meningitis:** Up to 100 mg/kg/day IV, divided every 12 hours. Maximum daily dose is 4 grams.
## Dose Adjustments
No dose adjustment is generally required for renal impairment. However, in severe renal impairment with concomitant hepatic impairment, the total daily dose may need to be reduced.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving concurrent IV calcium-containing solutions (risk of ceftriaxone-calcium precipitation).
## Adverse Effects
* Phlebitis at the injection site
* Diarrhea
* Rash
* Eosinophilia
* Thrombocytosis
* Biliary pseudolithiasis (especially in children)
* Rare: Stevens-Johnson syndrome, anaphylaxis, hepatic dysfunction, renal dysfunction, hemolytic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity and ototoxicity when used together, particularly in severe infections or in patients with renal dysfunction.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR.
* **Probenecid:** May increase ceftriaxone levels.
* **Calcium-containing solutions:** Life-threatening precipitation can occur in neonates. Avoid concurrent administration through the same IV line.
## Monitoring
* Signs and symptoms of infection (fever, elevated white blood cell count, etc.)
* Renal and hepatic function (baseline and periodically, especially with prolonged therapy or in patients with pre-existing dysfunction)
* Injection site for phlebitis.
* Signs of hypersensitivity reactions.
* INR if patient is on warfarin.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in most cases.
* It is one of the preferred agents for empiric treatment of community-acquired pneumonia, meningitis, and disseminated gonococcal infections.
* Do not use diluents containing calcium (e.g., Lactated Ringer's) to reconstitute ceftriaxone for IV administration.
* If ceftriaxone is administered via continuous infusion, it may be mixed with compatible IV solutions containing calcium, but this is generally not recommended due to the risk of precipitation.
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**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any decisions related to patient care.
