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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
* Bacterial meningitis (adjunctive therapy in some cases)
* Uncomplicated gonorrhea
* Surgical prophylaxis
* Febrile neutropenia (empiric therapy)
* Skin and soft tissue infections
* Urinary tract infections
* Biliary tract infections
* Intra-abdominal infections
* Osteomyelitis
* Septic arthritis
## Adult Dosing
* **General Infections:** 1 to 2 grams IV or IM every 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours, usually administered as 2 grams every 12 hours.
* **Uncomplicated Gonorrhea:** 250 mg IM single dose.
* **Surgical Prophylaxis:** 1 to 2 grams IV within 60 minutes prior to incision.
Specific dosing and duration depend on the site and severity of infection, and local antimicrobial stewardship guidelines.
## Pediatric Dosing
* **Neonates (< 7 days):** 25 to 50 mg/kg IV every 24 hours.
* **Infants and Children (> 7 days):**
* **General Infections:** 50 to 100 mg/kg/day IV or IM, divided into two doses (every 12 hours).
* **Severe Infections (e.g., meningitis):** Up to 100 mg/kg/day IV, not to exceed the adult maximum of 4 grams daily.
Dosing should not exceed the adult maximum of 4 grams per day.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically required in adults or children with impaired renal function, as ceftriaxone is extensively eliminated by non-renal mechanisms (hepatobiliary excretion).
* **Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (≤ 41 weeks postmenstrual age) receiving IV calcium-containing solutions or infusions, or requiring intermittent IV calcium-containing solutions due to risk of precipitation.
* Hyperbilirubinemic neonates.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, phlebitis at the injection site.
* **Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, eosinophilia, thrombocytopenia, leukopenia, hemolytic anemia, biliary sludge/cholelithiasis (especially in neonates), renal or biliary precipitation.
## Key Drug Interactions
* **Calcium-containing solutions:** Avoid concurrent administration via any route, particularly in neonates, due to risk of fatal precipitation in lungs and kidneys. If intermittent infusion is necessary, flush lines thoroughly between administrations.
* **Probenecid:** May increase and prolong ceftriaxone serum concentrations.
* **Warfarin:** Ceftriaxone may enhance the effect of warfarin. Monitor INR closely.
* **Aminoglycosides:** Increased risk of nephrotoxicity when used concurrently, especially at higher doses.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of *C. difficile* infection.
* Monitor complete blood count (CBC), liver function tests (LFTs), and renal function tests (RFTs) periodically, especially with prolonged therapy.
* Monitor for adverse effects such as rash or diarrhea.
* In neonates, monitor for signs of biliary or renal precipitation.
## Clinical Pearls
* Ceftriaxone is often a drug of choice for empiric treatment of meningitis in pediatric patients.
* Due to its long half-life, ceftriaxone can be dosed once daily for many indications.
* Avoid mixing ceftriaxone with solutions containing calcium or with other cephalosporins or penicillins.
* When reconstituting, use appropriate diluents as recommended by the manufacturer. IM reconstitution typically uses lidocaine hydrochloride 1% (without epinephrine) to minimize injection site pain.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any clinical decisions.
