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# Cefriaxone
## Overview
Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic with bactericidal activity against a wide range of Gram-positive and Gram-negative bacteria. It is administered via intramuscular (IM) or intravenous (IV) routes.
## Primary Indications
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Complicated urinary tract infections
* Skin and soft tissue infections
* Intra-abdominal infections
* Bacterial meningitis (as part of combination therapy or for specific pathogens)
* Sepsis
* Disseminated gonococcal infection
* Prophylaxis for surgical procedures
## Adult Dosing
* **General infections:** 1 to 2 grams (g) IV or IM every 24 hours.
* **Severe infections:** Doses up to 4 g IV daily in 2 equally divided doses (2 g every 12 hours).
* **Meningitis:** 2 g IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Disseminated gonococcal infection:** 1 g IV or IM every 24 hours for 7 days.
* **Surgical prophylaxis:** 1 to 2 g IV or IM 30 to 120 minutes before incision.
Maximum dose: 4 g daily.
## Pediatric Dosing
Dosing is weight-based and depends on the indication and severity of infection. Refer to institutional guidelines or pediatric infectious disease resources for specific pediatric dosing. General ranges:
* **Non-neonatal pediatric patients:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours. Maximum: 2 g daily.
* **Severe infections (e.g., meningitis):** Up to 100 mg/kg/day IV divided every 12 hours. Maximum: 4 g daily.
* **Neonates (0-14 days):** 25 to 50 mg/kg/day IV or IM divided every 24 hours. Maximum: 125 mg daily.
* **Neonates (15-28 days):** 50 mg/kg/day IV or IM divided every 24 hours. Maximum: 2 g daily.
**Note:** Ceftriaxone is contraindicated in hyperbilirubinemic neonates and neonates receiving IV calcium-containing solutions.
## Dose Adjustments
No dose adjustment is typically needed for renal or hepatic impairment. However, caution is advised in severe cases.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates with hyperbilirubinemia.
* Neonates receiving concomitant intravenous calcium-containing solutions.
## Adverse Effects
Common: Diarrhea, rash, nausea, vomiting, injection site pain/phlebitis.
Less common: Eosinophilia, leukopenia, thrombocytopenia, thrombocythemia, liver enzyme elevations, glycosuria, hematuria, headache, dizziness.
Rare: Anaphylaxis, Stevens-Johnson syndrome, renal precipitation, biliary sludging, pancreatitis, aplastic anemia, encephalopathy.
## Key Drug Interactions
* **Aminoglycosides:** May have additive or synergistic effect against certain bacteria, but increased risk of nephrotoxicity if used together.
* **Oral anticoagulants (e.g., warfarin):** Ceftriaxone may enhance the effect of oral anticoagulants by inhibiting vitamin K synthesis. Monitor INR closely.
* **Probenecid:** May decrease renal clearance of ceftriaxone, increasing serum levels.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of fatal precipitation in lungs and kidneys. This interaction can occur in adults as well; avoid concurrent administration through the same IV line.
## Monitoring
* Signs and symptoms of infection (fever, WBC count, inflammatory markers).
* Renal and hepatic function (especially in patients with pre-existing impairment or receiving other nephro/hepatotoxic agents).
* Electrolytes.
* Signs of hypersensitivity reactions.
* Prothrombin time/INR if co-administered with anticoagulants.
* For neonates: Monitor for signs of biliary or renal precipitation.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing in many adult indications.
* IM administration is typically well-tolerated and can be used when IV access is limited.
* Ceftriaxone can cause biliary sludging, which is usually asymptomatic and resolves after discontinuation.
* Due to potential for precipitation, avoid concurrent administration with calcium-containing solutions, particularly in neonates. Flush IV lines thoroughly between administrations.
* For suspected or confirmed *Neisseria meningitidis* meningitis, ceftriaxone is a common choice, but duration of therapy may vary based on pathogen susceptibility.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.
