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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 via intravenous (IV) or intramuscular (IM) routes.
## Primary Indications
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Meningitis (bacterial)
* Bone and joint infections
* Intra-abdominal infections
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Gonococcal infections
* Prophylaxis for surgical infections
## Adult Dosing
* **General infections:** 1 to 2 grams IV or IM every 12 or 24 hours.
* **Serious infections:** Up to 4 grams IV daily in divided doses (every 12 hours).
* **Meningitis:** 2 grams IV every 12 hours. Duration of therapy varies by pathogen.
* **Surgical prophylaxis:** 1 to 2 grams IV within 30 to 60 minutes prior to incision.
* **Uncomplicated gonorrhea:** 500 mg IM single dose.
* **Disseminated gonococcal infection:** 1 gram IV or IM every 24 hours for 7 days.
* **Pelvic inflammatory disease:** 250 mg IM single dose, followed by an oral regimen.
* **Maximum daily dose:** 4 grams.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV or IM every 24 hours. Maximum dose: 50 mg/kg/day. **Do not use in hyperbilirubinemic neonates or if needing calcium-containing IV fluids.**
* **Neonates (15-28 days) and children:** 50-100 mg/kg/day IV or IM in divided doses every 12 or 24 hours.
* **Serious infections/Meningitis:** Up to 100 mg/kg/day (maximum 4 grams) IV in divided doses every 8 or 12 hours.
## Dose Adjustments
No dose adjustment is required for hepatic impairment or renal impairment when either organ function is normal. In severe renal impairment (CrCl < 10 mL/min) not undergoing dialysis, the maximum daily dose should generally not exceed 2 grams. If dialysis is being performed, no dose adjustment is needed as ceftriaxone is not significantly removed by hemodialysis.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving concomitant calcium-containing IV solutions or total parenteral nutrition.
## Adverse Effects
Common adverse effects include rash, diarrhea, nausea, vomiting, phlebitis at the injection site, and eosinophilia. Less common but serious effects include:
* Hypersensitivity reactions (including anaphylaxis)
* Clostridioides difficile-associated diarrhea
* Biliary sludging (especially in neonates and children)
* Hemolytic anemia
* Thrombocytosis/thrombocytopenia
* Elevated liver enzymes
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity and ototoxicity, especially with high doses or prolonged therapy.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Warfarin:** Ceftriaxone may affect the response to warfarin. Monitor INR.
* **Calcium-containing solutions:** Contraindicated in neonates. Risk of precipitates in IV lines and lungs.
## Monitoring
* Monitor for signs and symptoms of allergic reactions.
* Assess for diarrhea and C. difficile infection.
* Monitor liver function tests and renal function, especially in patients with pre-existing impairment or receiving concomitant nephrotoxic agents.
* Consider monitoring for biliary sludging with prolonged therapy or in specific patient populations.
* Monitor INR if co-administered with warfarin.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine for adult patients; however, use of lidocaine is recommended for IM administration in pediatric patients to minimize pain.
* The long half-life allows for once or twice-daily dosing.
* It is a preferred agent for community-acquired pneumonia and meningitis.
* Always reconstitute according to manufacturer instructions and administer within the recommended time frame.
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*Please verify this information with the most current prescribing information and local institutional guidelines.*
