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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.
## Primary Indications
* Lower respiratory tract infections
* Urinary tract infections
* Skin and skin structure infections
* Complicated intra-abdominal infections
* Bacterial meningitis
* Disseminated gonococcal infections
* Sepsis
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours. Doses may be given every 12 hours for severe infections.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1 to 2 grams IV or IM 30-60 minutes before incision.
Maximum daily dose: 4 grams.
## Pediatric Dosing
* **Serious Infections:** 50 to 100 mg/kg/day IV or IM divided every 12 or 24 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
Maximum daily dose: 4 grams.
*Note: For neonates < 7 days of age, doses should not exceed 50 mg/kg/day due to increased risk of kernicterus.*
## Dose Adjustments
No dose adjustment is typically necessary for renal or hepatic impairment, as ceftriaxone is extensively protein-bound and cleared by both routes. However, careful monitoring is advised in severe impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Concurrent use with IV calcium-containing solutions in neonates (risk of precipitates).
## Adverse Effects
* Diarrhea
* Rash
* Phlebitis (at injection site)
* Eosinophilia
* Thrombocytosis
* Elevated liver enzymes
* Biliary sludge/cholelithiasis (especially with prolonged use or high doses)
* Hemolytic anemia (rare)
* Seizures (rare, typically with high doses and renal impairment)
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used concurrently.
* **Warfarin:** Ceftriaxone may inhibit vitamin K synthesis, potentially increasing the anticoagulant effect of warfarin. Monitor INR closely.
* **Probenecid:** May increase ceftriaxone levels.
* **Oral Contraceptives:** Reduced efficacy may occur.
## Monitoring
* Signs and symptoms of infection resolution.
* Renal and hepatic function (especially in patients with pre-existing impairment or risk factors).
* Bilirubin levels in neonates.
* Blood counts if prolonged therapy is anticipated.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone can be administered intramuscularly without lidocaine, but lidocaine can reduce injection site pain.
* Avoid concurrent administration of ceftriaxone and calcium-containing solutions in the same IV line, especially in neonates. If co-administration is necessary, flush the line thoroughly between doses.
* The long half-life of ceftriaxone (approximately 8 hours) allows for once-daily dosing in many indications.
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider and refer to current prescribing information for complete details.*
