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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
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Acute bacterial meningitis
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Bacterial skin and soft tissue infections
* Complicated urinary tract infections
* Bone and joint infections
* Sepsis
## Adult Dosing
* **General Infections:** 1 to 2 grams (g) intravenously (IV) or intramuscularly (IM) every 24 hours (q24h).
* **Severe Infections:** Up to 4 g IV q24h, divided into two 2 g doses every 12 hours (q12h).
* **Uncomplicated Gonorrhea:**
* Disseminated infection: 1 g IM once.
* Pharyngeal infection: 2.5 g IM once (often combined with azithromycin 1 g orally).
* **Meningitis:** 2 g IV q12h.
## Pediatric Dosing
* **General Infections:** 50 to 100 mg/kg/day IV or IM q24h.
* **Severe Infections:** Up to 150 mg/kg/day IV or IM q12h or q24h (maximum 4 g/day).
* **Meningitis:** 100 mg/kg/day IV q12h or q24h (maximum 4 g/day).
* **Neonates (< 7 days):** 25 to 50 mg/kg/day IV or IM q24h. Do not exceed 50 mg/kg/day in neonates due to risk of bilirubin displacement.
## Dose Adjustments
No dose adjustment is typically needed in patients with renal or hepatic impairment. However, caution is advised with severe renal impairment, especially if combined with hepatic impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (≤ 28 days) receiving IV calcium-containing solutions or infusions, including continuous parenteral nutrition, due to the risk of ceftriaxone-calcium precipitate formation.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
Serious: *Clostridioides difficile*-associated diarrhea, anaphylaxis, biliary sludge/gallstones (especially in pediatrics), hemolytic anemia, interstitial nephritis, seizures.
## Key Drug Interactions
* **Calcium-containing solutions/infusions:** Contraindicated in neonates (see contraindications). In adults, separate administration by at least 48 hours if both are administered IV.
* **Warfarin:** May decrease INR; monitor INR closely.
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count (CBC).
* Prothrombin time/INR (especially if on anticoagulants or with nutritional deficiencies).
* Bilirubin levels in neonates and infants.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine; however, use of lidocaine can reduce injection pain.
* Formulations exist that contain lidocaine for IM administration. Ensure correct formulation is used.
* The risk of biliary pseudolithiasis is increased with prolonged therapy and higher doses. Ultrasound monitoring may be considered.
* Ceftriaxone is a component of many empiric treatment regimens and is often used for outpatient parenteral antimicrobial therapy (OPAT).
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication. Dosing may vary based on specific clinical circumstances and patient factors.
