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# Ceftriaxone
## 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
* Gonorrhea
* Sepsis
* Bone and joint infections
* Perioperative prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams IV or IM every 24 hours.
* **Severe Infections/Meningitis:** 2 grams IV every 12 hours (maximum 4 grams daily).
* **Uncomplicated Gonorrhea:** 500 mg IM single dose.
* **Perioperative Prophylaxis:** 1 to 2 grams IV within 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (< 7 days):** 25-50 mg/kg IV or IM every 24 hours.
* **Neonates (> 7 days with birth weight < 2 kg):** 25-50 mg/kg IV or IM every 24 hours.
* **Neonates (> 7 days with birth weight ≥ 2 kg) and older infants/children:**
* **General Infections:** 50-100 mg/kg IV or IM every 24 hours (maximum 2 grams daily).
* **Meningitis:** 100 mg/kg IV every 12-24 hours (maximum 4 grams daily). Dosing for meningitis may be guided by local protocols.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment due to its unique pharmacokinetic profile (high protein binding and biliary excretion). However, very high doses in severe renal impairment may warrant caution.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 41 weeks post-conception) receiving IV calcium-containing solutions due to the risk of precipitation.
## Adverse Effects
* Phlebitis, pain at injection site
* Rash, pruritus
* Diarrhea
* Eosinophilia, thrombocytosis, leukopenia
* Biliary sludge/pseudolithiasis (especially in children)
* Rarely: Stevens-Johnson syndrome, anaphylaxis
## Key Drug Interactions
* **Calcium-containing solutions:** Do not mix or administer concurrently with IV calcium-containing solutions in any patient, especially neonates. Separate administration by at least 48 hours if both are required.
* **Aminoglycosides:** Potential for increased nephrotoxicity when used together, though not consistently demonstrated with ceftriaxone. Monitor renal function.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR.
## Monitoring
* Signs and symptoms of infection
* Renal and hepatic function (especially in severe impairment or with concurrent nephrotoxic agents)
* Complete blood count
* Prothrombin time (if on warfarin)
* Signs of hypersensitivity reactions
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in most adult indications.
* It is the drug of choice for disseminated gonococcal infections and Lyme disease.
* Biliary pseudolithiasis is a common, usually benign, finding in children and can resolve after discontinuation.
* Ceftriaxone is often used for empiric treatment of community-acquired pneumonia and meningitis in both adults and children.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.*
