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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 intravenously or intramuscularly.
## Primary Indications
* Pneumonia
* Bacterial meningitis
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Intra-abdominal infections
* Sepsis
* Gonorrhea
* Lyme disease (early disseminated)
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (1 gram IM for disseminated gonococcal infection).
* **Lyme Disease (Early Disseminated):** 1 to 2 grams IV every 24 hours for 14 to 21 days.
Dosing frequency and duration are guided by the severity of infection, pathogen, and patient response, often following local institutional protocols.
## Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg/day IV or IM every 24 hours. Maximum daily dose is 50 mg/kg.
* **Neonates (15-28 days) and Children < 12 years:** 50 to 100 mg/kg/day IV or IM divided every 12 or 24 hours. Maximum daily dose is 2 grams.
* **Children ≥ 12 years:** Dosing as per adult recommendations.
* **Bacterial Meningitis (all ages):** 80 to 100 mg/kg/day IV divided every 12 or 24 hours. Maximum daily dose is 4 grams.
Dosing in neonates should be carefully considered due to potential for bilirubin displacement.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally required as ceftriaxone is primarily eliminated by hepatic metabolism and biliary excretion. However, caution and close monitoring are advised in severe renal impairment.
* **Hepatic Impairment:** No dose adjustment is generally required.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 41 weeks post-conception) receiving IV calcium-containing solutions or infusions due to risk of precipitate formation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), biliary sludge/cholelithiasis, hemolytic anemia, renal impairment, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Aminoglycosides:** May increase risk of nephrotoxicity, especially in combination for severe Gram-negative infections. Monitor renal function.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Avoid concurrent IV administration in neonates.
## Monitoring
* Assess for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of *C. difficile* infection.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or receiving concurrent nephrotoxic agents.
* Monitor for therapeutic response (e.g., resolution of fever, improvement in clinical signs).
* Consider monitoring coagulation parameters if patient is on anticoagulants or has impaired synthesis.
* Monitor for biliary sludge formation with prolonged therapy.
## Clinical Pearls
* Ceftriaxone is often used for empiric treatment of community-acquired pneumonia, meningitis, and febrile neutropenia.
* IM administration is painful; lidocaine can be used as a diluent for IM injections (avoid in neonates).
* Ceftriaxone is a common choice for treating gonorrhea due to its long half-life and effective IM dosing.
* Displacement of bilirubin from albumin binding is a concern in neonates, potentially leading to kernicterus.
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*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information and institutional protocols before use.*
