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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
* Uncomplicated gonorrhea
* Skin and soft tissue infections
* Urinary tract infections
* Sepsis
* Prophylaxis for surgical procedures
## Adult Dosing
* **General:** 1-2 grams (g) every 12-24 hours (hr).
* **Severe infections:** Up to 4 g daily, divided every 12 hr.
* **Uncomplicated gonorrhea:** 250 milligrams (mg) intramuscularly (IM) as a single dose.
* **Surgical prophylaxis:** 1-2 g IV 30-60 minutes before incision.
Dosing may vary based on specific indication and institutional guidelines.
## Pediatric Dosing
* **Neonates (< 14 days):** 25-50 mg/kg/day IV every 24 hr.
* **Neonates (14 days to < 2 years):** 50-100 mg/kg/day IV/IM divided every 12-24 hr.
* **Children (> 2 years):** 50-100 mg/kg/day IV/IM divided every 12-24 hr.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hr (maximum 4 g/day).
Maximum daily dose in children should not exceed the adult maximum of 4 g/day.
## Dose Adjustments
No dose adjustment is typically required in patients with hepatic impairment or renal impairment alone. However, in severe renal impairment (CrCl < 10 mL/min) where the patient is not undergoing dialysis, the daily dose should not exceed 2 g. If the patient is undergoing dialysis, no dose adjustment is generally necessary; however, supplemental dose may be required after dialysis.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (term and preterm) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, hepatic dysfunction, renal dysfunction, cholelithiasis (especially in neonates), hematologic changes (eosinophilia, leukopenia, thrombocytopenia).
## Key Drug Interactions
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Aminoglycosides:** Potential for additive nephrotoxicity, though clinical significance is debated.
* **Warfarin:** May decrease INR; monitor INR closely.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of fatal precipitation in lungs and kidneys.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Complete blood count.
* Injection site for signs of phlebitis.
* Monitor for diarrhea, especially C. difficile.
## Clinical Pearls
* Ceftriaxone is primarily renally and hepatically eliminated, allowing for flexible dosing in many patients with organ dysfunction.
* Due to the risk of precipitation, do not mix or administer ceftriaxone simultaneously with calcium-containing solutions in any patient, regardless of age, via any route of administration.
* Ceftriaxone's long half-life allows for once-daily dosing in many indications.
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*This information is intended for clinical professionals and does not replace professional judgment. Always consult the most current prescribing information and institutional protocols before making therapeutic decisions.*
