Please check your internet connection and try again.
# 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 infections:** including pneumonia, meningitis, gonorrhea, skin and soft tissue infections, urinary tract infections, bone and joint infections, intra-abdominal infections, and sepsis.
* **Prophylaxis:** Surgical site infection prophylaxis.
## Adult Dosing
* **General infections:** 1-2 grams (g) intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours, typically divided into two 2-gram doses every 12 hours.
* **Uncomplicated gonorrhea:** 500 milligrams (mg) IM as a single dose.
* **Disseminated gonococcal infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Surgical prophylaxis:** 1-2 g IV 30-60 minutes before surgery.
* **Maximum dose:** Generally, 4 grams per 24 hours. Specific indications may have higher maximums, but these should be guided by local protocols and susceptibility data.
## Pediatric Dosing
Dosing varies significantly by indication and patient weight. Local protocols are essential.
* **General infections:** 50-100 mg/kg/day IV or IM divided every 12-24 hours.
* **Severe infections (e.g., meningitis):** Up to 100 mg/kg/day IV divided every 12 hours.
* **Neonates (< 7 days):** 25-50 mg/kg/day IV divided every 24 hours.
* **Neonates (7-14 days):** Dosing should be guided by local protocols; generally similar to infants.
* **Maximum dose:** Generally, 2 grams per dose for children and 4 grams per day for adolescents. However, doses up to 80-100 mg/kg/day with a maximum of 2g per day are used for certain indications.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally necessary due to high hepatic clearance. However, in severe renal impairment with concurrent hepatic dysfunction, monitoring may be considered.
* **Hepatic Impairment:** No dose adjustment is generally necessary.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* **Neonates (less than 28 days):** Ceftriaxone should NOT be administered with or infused via the same IV line as calcium-containing solutions or products, including parenteral nutrition, due to the risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis at the injection site.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludging (especially in neonates and children), hematologic abnormalities (eosinophilia, leukopenia, thrombocytopenia), Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Calcium-containing solutions:** Contraindicated in neonates. Caution in adults due to potential for precipitation in lungs and kidneys.
* **Aminoglycosides:** Potential for additive nephrotoxicity, though not consistently demonstrated with ceftriaxone.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR.
* **Live typhoid vaccine:** Ceftriaxone may reduce the efficacy of live typhoid vaccine.
## Monitoring
* **Clinical signs and symptoms of infection:** Resolution of fever, pain, and inflammation.
* **Culture and susceptibility results:** To guide therapy duration and de-escalation.
* **Renal and hepatic function:** Generally not required for routine dosing unless significant impairment or concurrent risk factors are present.
* **Injection site:** For signs of phlebitis or local reaction.
* **Biliary system:** Particularly in neonates and children receiving prolonged therapy or high doses, ultrasound may be considered if symptoms of biliary sludging arise.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing, improving convenience.
* Due to its broad spectrum, it is a common choice for empiric therapy in many serious infections.
* Always reconstitute and dilute according to manufacturer instructions.
* Avoid IM injection in patients with severe thrombocytopenia, anemia, or other conditions where IM injections may be contraindicated.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
