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# Cefriaxone ## Overview Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic with excellent activity against many Gram-positive and Gram-negative bacteria. It has a long half-life, allowing for once-daily dosing. ## Primary Indications * Complicated urinary tract infections (cUTIs) * Pneumonia (community-acquired and hospital-acquired) * Meningitis * Sepsis * Pelvic inflammatory disease * Disseminated gonococcal infections * Surgical prophylaxis * Lyme disease (early and late disseminated) ## Adult Dosing * **General infections:** 1-2 grams IV/IM every 24 hours. * **Severe infections:** Up to 4 grams IV every 24 hours, divided into two 2-gram doses administered every 12 hours. * **Disseminated gonococcal infections:** 1 gram IV/IM once. * **Lyme disease:** 2 grams IV every 24 hours for 14-21 days. * **Surgical prophylaxis:** 1-2 grams IV/IM given 30-60 minutes before incision. ## Pediatric Dosing Dosing varies significantly by indication and weight. **Consult institutional guidelines or pediatric infectious disease resources for specific pediatric dosing.** * **General guidelines:** * Neonates (0-14 days): 20-50 mg/kg IV/IM once daily. * Infants and Children (>14 days to 12 years): 50-100 mg/kg/day IV/IM, not to exceed 2 grams/day. * Children >12 years: Dosing similar to adults. * **Meningitis:** 100 mg/kg/day IV, not to exceed 4 grams/day, divided every 12 or 24 hours. ## Dose Adjustments * **Renal Impairment:** No dose adjustment is typically required in adults with renal impairment due to high biliary excretion. However, close monitoring is recommended in severe renal impairment. * **Hepatic Impairment:** No dose adjustment is typically required. ## Contraindications * Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics. * Neonates (≤ 28 days old) receiving IV calcium-containing solutions or infusions. This combination can lead to precipitation of ceftriaxone-calcium in the pulmonary and renal vasculature, which can be fatal. ## Adverse Effects * **Common:** Diarrhea, rash, eosinophilia, thrombocytosis, leukopenia, elevated