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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.
## Primary Indications
* Serious infections: pneumonia, meningitis, sepsis, intra-abdominal infections, bone and joint infections, skin and soft tissue infections, urinary tract infections, gonorrhea.
## Adult Dosing
* **General infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Serious infections:** Up to 4 grams IV per 24 hours, divided into two doses (every 12 hours).
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Disseminated gonococcal infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Meningitis:** 2 grams IV every 12 hours. Duration varies based on pathogen.
* **Surgical prophylaxis:** 1 to 2 grams IV or IM 30 to 60 minutes before incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours.
* **Neonates (15-28 days):** 25-50 mg/kg IV every 12 or 24 hours, depending on severity.
* **Infants and Children (> 28 days up to 12 years or < 50 kg):** 50-100 mg/kg/day IV or IM divided every 12-24 hours.
* **Children > 12 years or ≥ 50 kg:** Use adult dosing.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (maximum 4 grams/day).
* **Note:** Dosing may vary based on specific indication and local protocols. Avoid concurrent IV administration with calcium-containing solutions in neonates.
## Dose Adjustments
* **Renal impairment:** No dose adjustment generally required due to high biliary excretion. However, if severe renal impairment exists along with hepatic impairment, doses may need reduction.
* **Hepatic impairment:** No dose adjustment generally required. Monitor if severe hepatic impairment is present.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Concurrent use with calcium-containing solutions or products in neonates (risk of precipitation).
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at injection site.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge/cholelithiasis, pancreatitis, neutropenia, eosinophilia, thrombocytopenia.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity (monitor renal function).
* **Oral anticoagulants (e.g., warfarin):** May potentiate the effect of anticoagulants (monitor INR).
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions/products:** Contraindicated in neonates due to risk of precipitation.
## Monitoring
* Assess for signs and symptoms of infection.
* Monitor for adverse effects, particularly diarrhea and hypersensitivity reactions.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or on concurrent nephrotoxic agents.
* Monitor for signs of biliary sludge or cholelithiasis with prolonged use.
## Clinical Pearls
* Ceftriaxone is frequently used for empiric treatment of community-acquired pneumonia, meningitis, and complicated urinary tract infections.
* Its long half-life allows for once-daily dosing in many indications.
* Due to biliary excretion, it can be an effective option in patients with renal impairment.
* Ensure adequate hydration when administering IV.
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*Please verify the current prescribing information for the most up-to-date and complete details.*
