Cefriaxone%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252528ceftriaxone%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252529

# 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 * **Bacterial meningitis:** Particularly effective against *Streptococcus pneumoniae*, *Neisseria meningitidis*, and *Haemophilus influenzae*. * **Pneumonia:** Community-acquired pneumonia, including *S. pneumoniae* and *H. influenzae*. * **Skin and soft tissue infections:** Uncomplicated infections caused by *Staphylococcus aureus* (methicillin-susceptible strains) and *Streptococcus pyogenes*. * **Urinary tract infections:** Complicated and uncomplicated UTIs. * **Gonorrhea:** Uncomplicated urogenital, rectal, and pharyngeal gonorrhea. * **Sepsis:** Empiric treatment of suspected bacterial sepsis. * **Intra-abdominal infections:** Often used in combination with other agents. * **Bone and joint infections.** * **Lyme disease:** Particularly for neurologic or cardiac manifestations. ## Adult Dosing * **General infections:** 1 to 2 grams IV or IM every 12 to 24 hours. * **Severe infections:** Up to 4 grams IV per day divided every 12 hours. * **Meningitis:** 2 grams IV every 12 hours. Duration typically 7-21 days depending on the pathogen. * **Gonorrhea:** 500 mg IM single dose (1 gram IM for rectal or pharyngeal infections or for patients weighing >150 kg). * **Uncomplicated skin/soft tissue:** 1 gram IV or IM every 24 hours. * **Surgical prophylaxis:** 1 to 2 grams IV 30-60 minutes prior to incision. ## Pediatric Dosing * **General infections:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours. * **Severe infections:** Up to 150 mg/kg/day IV divided every 8 to 12 hours. Maximum daily dose for children is generally 4 grams. * **Meningitis:** 100 mg/kg/day IV divided every 12 hours. May increase to 80-100 mg/kg/dose every 8 hours for severe cases. Duration depends on pathogen (e.g., 7 days for *H. influenzae*, 10-14 days for *S. pneumoniae*, 7 days for *N. meningitidis*). * **Neonates (0-14 days):** 25-50 mg/kg/day IV divided every 24 hours. * **Neonates (15-28 days):** 50 mg/kg/day IV divided every 12 hours. * **Note:** Dosing for neonates can vary based on gestational age and birth weight; consult specific guidelines. Avoid concurrent IV calcium administration in neonates due to risk of precipitation. ## Dose Adjustments * **Renal impairment:** No dose adjustment is generally needed due to extensive hepatic excretion. However, caution and monitoring may be prudent in severe renal dysfunction. * **Hepatic impairment:** No dose adjustment is generally needed. ## Contraindications * Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation. * Concurrent use of intravenous calcium-containing solutions in neonates (under 28 days of age) due to risk of fatal precipitation in the lungs and kidneys. ## Adverse Effects * **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site, eosinophilia, thrombocytosis. * **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludging (especially in neonates and children), anaphylaxis, Stevens-Johnson syndrome, erythema multiforme, acute renal failure, Agranulocytosis, hemolytic anemia. ## Key Drug Interactions * **Probenecid:** May increase and prolong ceftriaxone levels. * **Aminoglycosides:** Potential for increased nephrotoxicity and ototoxicity, although synergy can occur for certain infections. Monitor drug levels and renal function. * **Warfarin:** Ceftriaxone may decrease the effect of warfarin; monitor INR. * **Calcium-containing solutions:** Fatal precipitation has been reported when ceftriaxone and calcium-containing solutions are mixed or administered concurrently in IV lines, especially in neonates. Ensure adequate flushing between administrations. ## Monitoring * Monitor for signs and symptoms of hypersensitivity reactions. * Assess for diarrhea and signs of *C. difficile* infection. * Monitor renal and hepatic function, especially in patients with pre-existing organ dysfunction or those receiving other nephrotoxic/hepatotoxic agents. * Monitor for signs of superinfection. * For neonates, monitor for signs of biliary sludging. ## Clinical Pearls * Ceftriaxone is highly protein-bound. * It can be administered IM without lidocaine in adults, but lidocaine is often used to minimize pain. For pediatric IM administration, lidocaine is usually recommended. * The long half-life allows for once or twice daily dosing for most indications. * Avoid concurrent use of intravenous calcium-containing solutions in neonates due to risk of fatal precipitation. Ensure adequate flushing of IV lines between administrations of ceftriaxone and calcium products in all patients. --- **Disclaimer:** This information is intended for clinical pharmacists and healthcare professionals. It is crucial to consult the most current prescribing information and institutional protocols for definitive guidance. Dosing may vary based on specific patient factors and clinical context.