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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
* **Serious infections:** Pneumonia, meningitis, gonorrhea, pelvic inflammatory disease, skin and soft tissue infections, bone and joint infections, intra-abdominal infections, and urinary tract infections.
* **Prophylaxis:** Surgical prophylaxis.
## Adult Dosing
* **General infections:** 1 to 2 grams IV or IM every 12 to 24 hours.
* **Severe or disseminated gonorrhea:** 250 mg IM as a single dose.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical prophylaxis:** 1 to 2 grams IV within 1 hour before incision.
* **Maximum daily dose:** Generally 4 grams.
## Pediatric Dosing
* **Neonates (< 28 days):** 25 to 50 mg/kg IV every 24 hours (higher doses may be used for meningitis). Avoid IV use with concurrent hyperbilirubinemia or in premature infants due to risk of bilirubin displacement.
* **Infants and Children (> 28 days):** 50 to 100 mg/kg IV or IM every 12 to 24 hours. For meningitis, doses up to 100 mg/kg IV every 12 hours may be used.
* **Maximum pediatric dose:** Generally 2 grams daily, except for meningitis where it can be up to 4 grams daily.
## Dose Adjustments
No dose adjustment is necessary for renal or hepatic impairment. However, prolonged therapy may warrant monitoring for hepatic function.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 28 days) receiving IV ceftriaxone concurrently with calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis, eosinophilia.
* **Serious:** Clostridioides difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), biliary sludge/gallstones, hemolytic anemia, neutropenia, thrombocytopenia.
## Key Drug Interactions
* **Calcium-containing solutions:** Risk of precipitation, especially in neonates. Do not mix or co-administer via the same IV line.
* **Warfarin:** May alter INR. Monitor INR closely.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for development of diarrhea; consider C. difficile testing if suspected.
* Monitor CBC, LFTs, and renal function with prolonged therapy.
* Monitor for signs of biliary sludge or gallstone formation, particularly in pediatric patients and those on prolonged therapy.
## Clinical Pearls
* Ceftriaxone is often a drug of choice for community-acquired pneumonia, meningitis, and gonorrhea.
* Its long half-life allows for once or twice daily dosing, improving patient compliance.
* IM administration may cause pain and local reactions.
* Consider alternative agents in patients with a history of severe IgE-mediated penicillin allergy.
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**Disclaimer:** This information is intended for educational purposes and should not replace consultation with the official prescribing information or local hospital protocols. Always verify current dosing and safety guidelines before administering any medication.
