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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
* Bacterial meningitis
* Pneumonia (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Sepsis
* Gonorrhea
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Severe/Complicated Infections:** Up to 4 grams IV daily, divided every 12 or 24 hours. Maximum dose: 4 grams daily.
* **Gonorrhea:** 500 mg IM as a single dose (1 gram IM for disseminated gonococcal infection).
Dosing frequency and duration depend on the site and severity of infection, as well as the causative pathogen.
## Pediatric Dosing
* **Neonates (< 7 days):** 25 to 50 mg/kg IV every 24 hours. Maximum dose: 50 mg/kg/day.
* **Neonates (7-28 days) and Children (> 28 days):** 50 to 100 mg/kg IV or IM daily, administered in one or two divided doses. Maximum dose: 2 grams daily.
* **Meningitis (Pediatric):** 100 mg/kg IV daily, divided every 12 hours. Maximum dose: 4 grams daily.
Consult local protocols for specific pediatric indications and dosing.
## Dose Adjustments
No dose adjustment is typically required for impaired renal function. However, in severe hepatic impairment or with concurrent renal impairment, the total daily dose may be reduced.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (less than 28 days old) receiving IV calcium-containing solutions or infusions.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludging (especially in neonates), hemolytic anemia, pancreatitis, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Calcium-containing solutions:** Avoid co-administration of IV ceftriaxone with calcium-containing solutions or infusions, especially in neonates, due to the risk of precipitates. Separate administration by at least 48 hours if both are necessary.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin, requiring increased monitoring of INR.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of C. difficile infection.
* Monitor complete blood counts and liver function tests with prolonged therapy.
* Monitor for biliary sludge formation, especially in neonates and patients with impaired hepatic or renal function.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing.
* It is an excellent choice for outpatient parenteral antimicrobial therapy (OPAT) due to its dosing convenience and IM administration option.
* Due to its potential to form precipitates with calcium, careful consideration is needed for IV administration in neonates and patients receiving calcium-containing fluids.
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*Please verify current prescribing information and consult with a healthcare professional for specific patient management decisions.*
