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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
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Meningitis (bacterial)
* Bone and joint infections
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Skin and soft tissue infections
* Urinary tract infections
* Sepsis
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe infections:** Up to 4 grams IV daily, divided every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Disseminated gonococcal infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Surgical prophylaxis:** 1 to 2 grams IV 30 to 120 minutes before surgery.
Dosing may vary based on the specific indication, severity of infection, and local institutional guidelines.
## Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days):** 50 mg/kg IV every 12 or 24 hours, depending on severity.
* **Infants and Children (>28 days to 12 years):** 50 to 100 mg/kg IV or IM daily, divided every 12 to 24 hours.
* **Severe infections (pediatric):** Up to 100 mg/kg IV daily, divided every 12 hours. Do not exceed 4 grams IV daily.
Dosing for meningitis in children is typically 100 mg/kg/day IV, divided every 12-24 hours. Dosing for pediatric patients weighing >50 kg should follow adult dosing guidelines.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally needed in adults with impaired renal function, as ceftriaxone is cleared by both renal and hepatic routes. However, in severe renal impairment (CrCl <10 mL/min), doses up to 2 grams daily may be considered, though evidence is limited.
* **Hepatic Impairment:** No dose adjustment is generally needed.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or any component of the formulation.
* Neonates (≤ 28 days) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, severe allergic reactions (anaphylaxis), biliary sludging (especially in neonates), hemolytic anemia, renal impairment, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity and ototoxicity, especially with concurrent use for serious infections.
* **Warfarin:** Ceftriaxone may alter the anticoagulant effects of warfarin; monitor INR closely.
* **Calcium-containing solutions (IV):** Contraindicated in neonates due to precipitation risk in the lungs and kidneys. Avoid concurrent administration in all age groups, though separation of administration times may be acceptable if necessary.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (especially with prolonged therapy or in patients with pre-existing impairment).
* Hematologic parameters (if prolonged therapy).
* Electrolytes.
* Biliary system (especially in neonates or those at risk for sludging).
## Clinical Pearls
* Ceftriaxone is often a drug of choice for empiric treatment of serious community-acquired infections, including meningitis and pneumonia, due to its broad spectrum and favorable pharmacokinetic profile allowing for once or twice-daily dosing.
* For IM administration, lidocaine 1% can be used as the diluent to minimize injection site pain.
* Ceftriaxone is not removed by hemodialysis.
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***Disclaimer:** This information is intended for healthcare professionals. Please consult the most current prescribing information and institutional protocols for complete details and to verify dosage and administration guidelines before use.*
