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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
* Pneumonia
* Meningitis
* Bacterial sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Gonorrhea
* Lyme disease (disseminated)
## 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 every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Disseminated Gonococcal Infections:** 1 gram IM or IV once.
* **Lyme Disease (Disseminated):** 2 grams IV every 24 hours for 14 to 21 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30 to 120 minutes before surgery.
Dosing may vary based on the specific infection and severity; consult local protocols.
## Pediatric Dosing
* **General Infections:** 50 to 100 mg/kg/day IV or IM in 1 to 2 divided doses. Maximum 2 grams/day.
* **Severe Infections:** Up to 150 mg/kg/day IV in 2 to 3 divided doses. Maximum 4 grams/day.
* **Meningitis:** 100 mg/kg/day IV in 2 divided doses. Maximum 4 grams/day.
* **Neonates (0-14 days):** 25 to 50 mg/kg/day IV in 1 dose.
* **Neonates (15-28 days):** 50 mg/kg/day IV in 2 divided doses.
Dosing must be weight-based and adjusted for age and renal function; consult specific pediatric guidelines. **Note:** Ceftriaxone is contraindicated in hyperbilirubinemic neonates.
## Dose Adjustments
No dose adjustment is generally required in mild to moderate hepatic impairment. In severe hepatic impairment, monitor closely. In renal impairment, no dose adjustment is needed if hepatic function is normal. If both renal and hepatic function are impaired, dosage reduction or monitoring may be necessary.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates with hyperbilirubinemia, especially premature neonates.
* Concurrent or recent administration of IV calcium-containing solutions in neonates (risk of precipitation).
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, phlebitis.
Serious: Anaphylaxis, *Clostridioides difficile*-associated diarrhea, biliary sludging, renal impairment, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together, especially in severe infections or renal impairment.
* **Warfarin:** May alter anticoagulant effects; monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Potentially fatal precipitates can form in lungs and kidneys of neonates if administered concurrently or within 48 hours of each other.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for effectiveness and adverse effects (e.g., diarrhea).
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or those receiving other nephrotoxic agents.
* Monitor for signs of *C. difficile* infection.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine, but lidocaine may reduce injection site pain.
* Biliary sludging can occur, particularly in children and with prolonged treatment. It is usually asymptomatic and resolves after discontinuation.
* Ceftriaxone is often used for empiric treatment of community-acquired pneumonia and meningitis.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
