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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 parenterally.
## Primary Indications
* Lower respiratory tract infections (e.g., pneumonia)
* Meningitis
* Bone and joint infections
* Intra-abdominal infections
* Skin and soft tissue infections
* Urinary tract infections
* Sepsis
* Gonorrhea
## Adult Dosing
* **General:** 1-2 grams (g) intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Serious Infections:** Up to 4 g IV per day, divided every 12 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Uncomplicated Gonorrhea:** 250 mg IM as a single dose.
* **Surgical Prophylaxis:** 1-2 g IV 30-60 minutes prior to surgery.
## Pediatric Dosing
Dosing varies significantly based on indication and weight. Specific protocols should be followed.
* **General Infections:** 50-100 mg/kg/day IV or IM divided every 12 to 24 hours.
* **Serious Infections:** Up to 150 mg/kg/day IV divided every 8 to 12 hours (maximum 2 g/day for infants < 2 weeks).
* **Meningitis:** 100 mg/kg/day IV divided every 12 to 24 hours.
* **Neonates (< 7 days or < 2 kg):** 25-50 mg/kg/day IV divided every 24 hours.
* **Neonates (7-14 days or > 2 kg):** 50 mg/kg/day IV divided every 12 hours.
## Dose Adjustments
No dose adjustment is generally needed in hepatic impairment. In severe renal impairment (CrCl < 10 mL/min), the total daily dose may be halved if the patient is receiving doses higher than 1 g daily. However, if the patient is also receiving hepatic co-administration, no adjustment is generally needed.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 28 days) receiving IV calcium-containing solutions concurrently or through the same IV line due to risk of precipitation.
## Adverse Effects
* Phlebitis, pain at injection site
* Diarrhea, nausea, vomiting
* Rash, pruritus
* Eosinophilia, thrombocytosis, leukopenia
* Elevated liver enzymes
* Biliary pseudolithiasis (especially in children)
* Hemolytic anemia (rare)
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity or ototoxicity. Monitor renal function and drug levels.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR.
* **Probenecid:** May increase ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates.
## Monitoring
* Renal function (BUN, creatinine)
* Liver function tests
* Complete blood count (CBC)
* Signs and symptoms of infection
* Injection site for signs of phlebitis
## Clinical Pearls
* Ceftriaxone is highly protein-bound, which contributes to its long half-life, allowing for once or twice-daily dosing.
* Do not mix or administer ceftriaxone simultaneously with calcium-containing solutions in any patient, especially neonates, due to the risk of fatal precipitation in the lungs and kidneys.
* For IM administration, reconstitute with the appropriate diluent and administer deeply into a large muscle mass.
* For IV administration, reconstitute and further dilute to appropriate concentration (e.g., 10-40 mg/mL) for infusion over 15-30 minutes or as a bolus over 2-4 minutes.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant institutional protocols for complete details and to ensure patient safety.*
