Please check your internet connection and try again.
# 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*, *Streptococcus pneumoniae*, *Haemophilus influenzae*).
* Pneumonia (community-acquired and hospital-acquired).
* Sepsis.
* Skin and soft tissue infections.
* Urinary tract infections.
* Pelvic inflammatory disease.
* Gonorrhea.
* Surgical prophylaxis.
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 12-24 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 as a single dose.
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV/IM every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days):** 25-50 mg/kg IV/IM every 12-24 hours.
* **Children (>28 days):** 50-100 mg/kg/day IV/IM, divided every 12-24 hours.
* **Severe infections/Meningitis:** Up to 100 mg/kg/day IV, divided every 12-24 hours (maximum 4 grams/day).
*Note: Dosing for neonates requires careful consideration of gestational and chronological age due to increased risk of bilirubin displacement and kernicterus.*
## Dose Adjustments
No dose adjustment is typically required for impaired renal function. However, if concomitant hepatic impairment is present, doses may need to be reduced, or dosing interval adjusted, based on local protocols and clinical response.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Concurrent use with IV calcium-containing solutions in neonates (risk of precipitation).
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, phlebitis.
Less Common: Leukopenia, eosinophilia, thrombocytosis, liver enzyme elevations, headache, dizziness.
Rare: *Clostridioides difficile*-associated diarrhea, anaphylaxis, hemolytic anemia, biliary sludge/gallstones (especially in neonates and with prolonged therapy).
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may alter the effect of warfarin. Monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions:** Avoid concurrent administration, particularly in neonates, due to risk of precipitation. Separate administration by at least 48 hours.
## Monitoring
* Clinical signs and symptoms of infection.
* Culture and sensitivity results.
* Renal and hepatic function.
* Complete blood count.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone is frequently used for empiric therapy of community-acquired infections, including meningitis and pneumonia.
* Its long half-life allows for once or twice-daily dosing.
* Due to biliary excretion, caution is advised in patients with hepatic insufficiency and in neonates.
* Administer IM doses deeply into a large muscle. IV administration can be given as a bolus or infusion.
* Reconstituted solutions are stable for specified periods at room temperature or refrigerated, depending on the diluent. Always refer to manufacturer's guidelines for reconstitution and storage.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.*
