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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 (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections, including pyelonephritis
* Intra-abdominal infections
* Gonorrhea (uncomplicated and complicated)
* Sepsis
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 12 to 24 hours.
* **Meningitis:** 2 grams IV every 12 hours. Maximum daily dose is 4 grams.
* **Disseminated Gonococcal Infections:** 1 gram IV/IM once.
* **Uncomplicated Gonorrhea:** 500 mg IM once.
* **Surgical Prophylaxis:** 1-2 grams IV within 60 minutes before incision.
Dosing frequency and duration depend on the site and severity of infection, as per local protocols and clinical judgment.
## Pediatric Dosing
* **Neonates (< 7 days):** 25-50 mg/kg IV every 24 hours.
* **Neonates (7-14 days):** 25-50 mg/kg IV every 24 hours.
* **Neonates (> 14 days):** 50-100 mg/kg IV every 12 to 24 hours.
* **Children (> 12 years):** Dosing typically follows adult recommendations.
* **Children (for serious infections like meningitis):** Dosing up to 100 mg/kg/day (maximum 4 grams/day) divided every 12-24 hours.
Note: Ceftriaxone is generally not recommended in neonates due to the risk of bilirubin displacement and kernicterus. Specific dosing should be guided by local institutional protocols.
## Dose Adjustments
No dose adjustment is typically required for hepatic or renal impairment when used alone. However, if both are severely impaired, monitoring may be considered. In severe hepatic impairment with significant renal impairment, doses should not exceed 2 grams daily.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (birth to 28 days) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis at injection site, eosinophilia, thrombocytosis.
* **Serious:** Severe hypersensitivity reactions (anaphylaxis), Clostridioides difficile-associated diarrhea, biliary sludge or gallstones, hemolytic anemia, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity, especially in severe infections or renal impairment.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Warfarin:** May alter INR. Monitor INR closely.
* **Calcium-containing solutions/products:** Contraindicated in neonates. Avoid concurrent administration with IV calcium in any patient.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function periodically, especially with prolonged therapy or in patients with pre-existing impairment.
* Complete blood count with differential and platelet count.
* Signs of hypersensitivity reactions.
* Electrolytes if concerns for imbalance.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing, which can simplify treatment regimens.
* Can be administered IM without lidocaine (though lidocaine may be used for patient comfort).
* In neonates, prolonged administration may increase bilirubin levels and the risk of kernicterus.
* Biliary precipitation (sludge or stones) is a known side effect, particularly with prolonged or high-dose therapy. This is usually reversible upon discontinuation.
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_This information is intended for healthcare professionals. Always verify current prescribing information and consult with appropriate resources before making clinical decisions._
