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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 (IV) or intramuscular (IM) routes.
## Primary Indications
* Pneumonia
* Meningitis (bacterial)
* Intra-abdominal infections
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Sepsis
* Gonorrhea
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1-2 grams IV or 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 as a single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV within 60 minutes prior to incision.
## Pediatric Dosing
Dosing is highly dependent on indication and weight. Local protocols should be consulted.
* **Neonate (0-14 days):** 25-50 mg/kg/day IV or IM divided every 24 hours.
* **Neonate (>14 days):** 50-100 mg/kg/day IV or IM divided every 12 hours.
* **Children (>12 years or >50 kg):** Adult doses apply.
* **Children (older than 14 days, <50 kg):** 50-100 mg/kg/day IV or IM divided every 12 hours. Maximum dose 2 grams/day.
* **Meningitis (pediatric):** 80-100 mg/kg/day IV divided every 12 or 24 hours. Maximum dose 4 grams/day.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is necessary when used alone. However, if co-administered with agents that displace ceftriaxone from albumin (e.g., certain NSAIDs), monitor for potential toxicity, especially in neonates.
* **Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 41 weeks postmenstrual age) with hyperbilirubinemia, particularly if receiving calcium-containing IV solutions. There is a risk of ceftriaxone-calcium precipitates in the lungs and kidneys.
## Adverse Effects
* Diarrhea
* Rash, pruritus
* Eosinophilia
* Thrombocytosis
* Pain and induration at the injection site
* Phlebitis
* Rarely: Stevens-Johnson syndrome, anaphylaxis, hepatic dysfunction, renal dysfunction, biliary sludge/cholelithiasis (especially in neonates and prolonged therapy).
## Key Drug Interactions
* **Calcium-Containing IV Solutions (in neonates):** Contraindicated due to risk of precipitation.
* **Aminoglycosides:** Potential for increased nephrotoxicity when used together.
* **Warfarin:** May decrease the effect of warfarin; monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Oral Contraceptives:** May reduce efficacy.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function, especially with prolonged therapy or in patients with pre-existing organ dysfunction.
* For signs of hypersensitivity reactions.
* For development of Clostridioides difficile-associated diarrhea.
## Clinical Pearls
* Ceftriaxone is highly protein-bound.
* It has a long half-life, allowing for once or twice-daily dosing.
* Administer IM injections deep into a large muscle. For IV administration, dilute and infuse slowly to minimize phlebitis.
* Avoid concurrent use with calcium-containing solutions in neonates.
* Ceftriaxone can interfere with certain laboratory tests (e.g., glucose urine tests).
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*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines for complete details and to ensure patient-specific appropriateness.*
