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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 via intravenous or intramuscular routes.
## Primary Indications
* Skin and skin structure infections
* Complicated urinary tract infections
* Pneumonia (community-acquired and hospital-acquired)
* Bacterial meningitis
* Sepsis
* Gonorrhea and Pelvic Inflammatory Disease
* Disseminated Lyme disease
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 12-24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infection, 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV within 60 minutes prior to incision.
Dosing frequency and duration depend on the type and severity of infection. Specific dosing for certain indications may vary based on local protocols.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 125 mg/day. **Note:** Ceftriaxone is contraindicated in neonates with hyperbilirubinemia or those requiring concurrent calcium-containing IV solutions.
* **Neonates (15-28 days):** 50 mg/kg IV every 24 hours.
* **Children (> 28 days to 12 years):**
* **General Infections:** 50-100 mg/kg/day IV or IM divided every 12-24 hours.
* **Severe Infections:** Up to 100 mg/kg/day, not to exceed 2 grams daily.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (maximum 4 grams/day).
* **Children (> 12 years):** Same as adult dosing.
## Dose Adjustments
No dose adjustment is necessary for renal or hepatic impairment when given at standard doses. However, in severe renal impairment with concomitant hepatic impairment, the total daily dose should not exceed 2 grams.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates with hyperbilirubinemia.
* Neonates requiring (or likely to require) intravenous treatment with calcium-containing solutions, regardless of the route of administration (IV or intermittent infusion).
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at the injection site.
* **Serious:** Severe hypersensitivity reactions (anaphylaxis), Clostridioides difficile-associated diarrhea, biliary sludge/pseudolithiasis (especially in pediatric patients), blood dyscrasias, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, particularly with higher doses.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin, requiring increased monitoring of INR.
* **Calcium-containing solutions:** Do not mix or administer ceftriaxone simultaneously with calcium-containing solutions, even via different infusion lines. This can lead to precipitation of ceftriaxone-calcium salt.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea; assess for C. difficile-associated diarrhea if it occurs.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or receiving other nephrotoxic/hepatotoxic agents.
* Monitor coagulation parameters if patient is on anticoagulants or has bleeding disorders.
* Monitor for biliary sludge formation, particularly in pediatric patients.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing, which improves patient compliance.
* For IM administration, reconstitute with sterile water for injection or 1% lidocaine hydrochloride solution (do not use lidocaine in neonates).
* For IV administration, reconstitute with sterile water for injection, D5W, or NS.
* Ceftriaxone is generally considered safe and effective for treatment of Lyme disease in endemic areas.
* Biliary pseudolithiasis is a common, usually asymptomatic, finding. If symptomatic, management may include discontinuation of ceftriaxone or medical management.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and institutional guidelines before administering any medication.*
