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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
* Treatment of serious bacterial infections including:
* Pneumonia
* Meningitis
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Gonorrhea (uncomplicated)
* Prophylaxis for surgical infections
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Severe Infections:** Up to 4 grams IV per day, divided every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infections, 1 gram IV or IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (< 14 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days):** 50 mg/kg IV every 12 hours.
* **Infants and Children (> 28 days to 12 years):**
* **General Infections:** 50-100 mg/kg/day IV or IM, divided every 12 or 24 hours.
* **Severe Infections:** Up to 150 mg/kg/day IV, divided every 8-12 hours. Maximum dose 2 grams per day.
* **Children > 12 years:** Adult dosing.
* **Meningitis:** 100 mg/kg/day IV, divided every 12 hours. Maximum dose 4 grams per day. Duration varies by pathogen.
* **Note:** For doses exceeding 1 gram in neonates, consider separate administration to avoid precipitation. Specific recommendations for neonates and patients with hyperbilirubinemia should be followed.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically necessary for adults or children with normal renal function due to significant biliary excretion. However, for severe renal impairment (CrCl < 10 mL/min) in adults, doses higher than 2 grams may require consideration.
* **Hepatic Impairment:** No dose adjustment is typically necessary.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (< 41 weeks gestational age and < 28 days postnatal age) receiving concurrent IV calcium-containing solutions or infusions due to risk of ceftriaxone-calcium precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludging, kernicterus (in neonates), hematologic abnormalities (eosinophilia, leukopenia, thrombocytopenia).
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together, particularly in severe infections or with renal impairment.
* **Warfarin:** Ceftriaxone may alter the effect of warfarin. Monitor INR closely.
* **Calcium-containing solutions (especially in neonates):** High risk of fatal ceftriaxone-calcium precipitation in the lungs and kidneys.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (baseline and periodically if indicated).
* Electrolytes.
* Signs of hypersensitivity reactions.
* For neonates, monitor for signs of kernicterus and precipitation.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once or twice daily dosing, improving adherence.
* It is often a preferred agent for community-acquired pneumonia, meningitis, and gonorrhea.
* Biliary sludging is common and usually asymptomatic; it typically resolves after discontinuation of the drug.
* Avoid use of IV calcium-containing fluids simultaneously with ceftriaxone in neonates.
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*Please verify the current prescribing information for complete details and any updates.*
