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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
* Serious infections, including pneumonia, meningitis, sepsis, bone and joint infections, skin and soft tissue infections, and urinary tract infections.
* Prophylaxis for surgical procedures.
* Treatment of gonorrhea.
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously or intramuscularly every 24 hours. For severe infections, doses may be increased to 4 grams per day, divided into two doses (every 12 hours).
* **Meningitis:** 2 grams intravenously every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg intramuscularly as a single dose. For disseminated gonococcal infections, 1 gram intravenously or intramuscularly every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams intravenously 30-60 minutes before the procedure.
## Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg intravenously every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days) and Children < 12 years:** 50 to 100 mg/kg intravenously or intramuscularly every 24 hours. For severe infections, doses may be increased to 150 mg/kg/day, divided into two doses (every 12 hours). Do not exceed 4 grams per day.
* **Children ≥ 12 years:** Dosing as per adult guidelines.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed if hepatic function is adequate.
* **Hepatic Impairment:** No dose adjustment is typically needed if renal function is adequate.
* **Combined Renal and Hepatic Impairment:** Use with caution and monitor drug levels if available.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Use in hyperbilirubinemic neonates, particularly those receiving calcium-containing intravenous solutions, due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, injection site reactions (pain, phlebitis).
* **Serious:** Anaphylaxis, C. difficile-associated diarrhea, biliary sludge or pseudolithiasis, renal or hepatic dysfunction, hematologic changes (eosinophilia, leukopenia, thrombocytopenia).
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may alter the anticoagulant response; monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone plasma levels.
* **Calcium-containing solutions:** Avoid co-administration in neonates due to risk of fatal precipitation. Separate administration by at least 48 hours if both are necessary.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for development of diarrhea or C. difficile infection.
* Monitor renal and hepatic function, and complete blood count, particularly with prolonged therapy or in patients with pre-existing organ dysfunction.
* Monitor INR if co-administered with warfarin.
## Clinical Pearls
* Ceftriaxone can be administered intramuscularly without lidocaine, though lidocaine may reduce injection site pain.
* Reconstituted solutions are stable for specified times at room temperature or refrigerated; consult specific product information.
* Discontinue if hypersensitivity reaction occurs.
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*Please verify this information against the most current prescribing information and institutional protocols.*
