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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
* Community-acquired pneumonia
* Pneumonia acquired in healthcare settings (often in combination)
* Skin and soft tissue infections
* Urinary tract infections, including pyelonephritis
* Sepsis
* Gonorrhea
* Pelvic inflammatory disease
* Lyme disease (early disseminated)
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams intravenously or intramuscularly every 24 hours.
* **Severe infections:** Doses up to 4 grams intravenously per day, divided into two 2-gram doses every 12 hours, may be used.
* **Meningitis:** 2 grams intravenously every 12 hours.
* **Uncomplicated gonorrhea:** 250 mg intramuscularly as a single dose.
* **Surgical prophylaxis:** 1 to 2 grams intravenously 30-60 minutes before incision.
Dosing frequency and duration of therapy depend on the type and severity of infection, as guided by clinical assessment and local protocols.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg intravenously every 24 hours.
* **Neonates (>14 days) and Children < 12 years:** 50-100 mg/kg intravenously or intramuscularly every 24 hours. Maximum dose: 2 grams per day.
* **Children > 12 years:** Dosing is the same as adults.
* **Meningitis (Pediatric):** 100 mg/kg intravenously every 24 hours, not to exceed 4 grams per day.
Dosing for neonates should not exceed the adult maximum dose.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment due to extensive biliary and renal excretion. However, monitor closely in severe impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactams.
* Concurrent use of intravenous calcium-containing solutions in neonates (risk of precipitation).
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis (at injection site).
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), eosinophilia, thrombocytosis, leukopenia, hemolytic anemia, biliary sludge/cholelithiasis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with high doses or prolonged therapy.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR closely and adjust warfarin dose as needed.
* **Calcium-containing solutions:** Concurrent administration in neonates can lead to fatal precipitation in the lungs and kidneys. Separate administration by at least 48 hours if both are required.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of *C. difficile*-associated diarrhea.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing impairment.
* Monitor for signs of biliary sludge or cholelithiasis, particularly in children and with prolonged use.
* If co-administered with warfarin, monitor INR.
## Clinical Pearls
* Ceftriaxone is often a preferred agent for empiric treatment of community-acquired meningitis and pneumonia.
* Due to its long half-life, once-daily dosing is convenient.
* It is frequently used for outpatient parenteral antimicrobial therapy (OPAT) due to its suitability for IM administration and once-daily dosing.
* The potential for biliary pseudolithiasis is a recognized adverse effect, especially in pediatric patients and with prolonged therapy.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider for any questions regarding drug therapy.*
