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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.
## Primary Indications
* Pneumonia (community-acquired)
* Meningitis (bacterial)
* Intra-abdominal infections
* Skin and soft tissue infections
* Urinary tract infections
* Gonococcal infections
* Sepsis
* Prophylaxis for surgical procedures
## Adult Dosing
* **General Infections:** 1 to 2 grams IV/IM every 24 hours.
* **Severe Infections:** May increase to 4 grams IV every 24 hours, divided into two doses (2 grams every 12 hours).
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM once.
* **Disseminated Gonococcal Infection:** 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV/IM 30-60 minutes before surgery.
## Pediatric Dosing
Dosing varies significantly by indication and weight. **Consult specific pediatric guidelines or infectious disease specialists.** General ranges include:
* **< 2 weeks:** 25-50 mg/kg IV every 24 hours.
* **2 weeks to 12 years:** 50-100 mg/kg IV/IM every 24 hours, not to exceed 2 grams per dose or 4 grams per day.
* **Meningitis (≥ 7 days):** 100 mg/kg/day IV divided every 12 hours, not to exceed 4 grams per day.
## Dose Adjustments
No dose adjustment is needed for renal or hepatic impairment. However, monitor closely as significant impairment may require dose adjustments, especially in combination with other renally cleared drugs.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates receiving IV calcium-containing solutions (risk of precipitate formation).
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis, eosinophilia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), biliary sludge or pseudolithiasis, leukopenia, thrombocytopenia, hemolytic anemia, renal failure.
## Key Drug Interactions
* **Calcium-containing solutions:** Do not co-administer IV ceftriaxone and IV calcium solutions in neonates due to risk of fatal precipitate formation in lungs and kidneys. In adults, avoid simultaneous IV administration through the same line. If concurrent use is necessary, flush the line thoroughly between infusions.
* **Warfarin:** Ceftriaxone may alter the anticoagulant effect of warfarin. Monitor INR closely.
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together.
* **Probenecid:** May increase ceftriaxone serum levels.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count.
* Signs of hypersensitivity reactions.
* Biliary system (especially in neonates and with prolonged therapy).
## Clinical Pearls
* Ceftriaxone is typically administered intramuscularly or intravenously. Intramuscular injections are often mixed with 1% lidocaine to reduce pain.
* Due to its long half-life, once-daily dosing is effective for many indications.
* Ceftriaxone crosses the blood-brain barrier and is a preferred agent for empiric treatment of bacterial meningitis in many settings.
* Discontinue immediately if a hypersensitivity reaction occurs.
* Biliary pseudolithiasis is a common, usually benign, and reversible side effect that may mimic cholecystitis.
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*Please verify this information with the most current prescribing information, institutional protocols, and patient-specific factors.*
