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# Cefriaxone
## Overview
Cefriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is administered parenterally.
## Primary Indications
* Serious bacterial infections including meningitis, sepsis, pneumonia, intra-abdominal infections, skin and soft tissue infections, bone and joint infections, and urinary tract infections.
* Gonococcal infections.
* Prophylaxis for surgical site infections.
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours. In severe infections, doses up to 4 grams IV every 24 hours may be administered.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonococcal Infections:** 500 mg IM as a single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **General Infections (≥ 1 month):** 50 to 100 mg/kg/day IV or IM divided into two doses (every 12 hours). Doses up to 150 mg/kg/day divided every 8-12 hours may be used for more severe infections.
* **Meningitis (≥ 1 month):** 100 mg/kg/day IV divided every 12 hours. A maximum daily dose of 4 grams should not be exceeded.
* **Neonates (< 1 month):** 25 to 50 mg/kg/day IV divided every 24 hours. In certain severe infections, higher doses may be considered under strict medical supervision. **Note:** Cefriaxone is contraindicated in neonates receiving IV calcium-containing solutions.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally required in adults with impaired renal function, as cefriaxone undergoes non-renal elimination. However, monitoring may be prudent in severe impairment or if co-administered with other renally cleared drugs.
* **Hepatic Impairment:** No dose adjustment is generally required.
## Contraindications
* Hypersensitivity to cefriaxone, other cephalosporins, or penicillins.
* Neonates (term or premature) receiving IV calcium-containing solutions or any parenteral nutrition containing calcium.
## Adverse Effects
Common: Diarrhea, rash, eosinophilia, thrombocytosis, phlebitis at the injection site.
Less Common: Leukopenia, nausea, vomiting, abdominal pain, elevated liver enzymes, headache, dizziness, fungal overgrowth.
Rare: *Clostridioides difficile*-associated diarrhea, anaphylaxis, seizures, biliary sludging (especially in neonates), renal impairment.
## Key Drug Interactions
* **Calcium-containing solutions/products:** Avoid concomitant IV administration in all patients, particularly neonates, due to risk of precipitation in lungs and kidneys. If necessary, administer sequentially through separate IV lines.
* **Aminoglycosides:** Potential for increased nephrotoxicity; monitor renal function.
* **Warfarin:** May alter INR; monitor closely.
* **Probenecid:** May increase cefriaxone levels.
## Monitoring
* Assess for signs and symptoms of infection.
* Monitor for allergic reactions.
* Monitor for diarrhea and assess for *C. difficile*.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment or receiving other nephrotoxic/hepatotoxic agents.
* Monitor prothrombin time/INR in patients on anticoagulants.
## Clinical Pearls
* Reconstitute cefriaxone with appropriate diluent (e.g., sterile water for injection, bacteriostatic water for injection, or lidocaine HCl 1% for IM use). Lidocaine should NOT be used for IV administration.
* Cefriaxone can be administered IM or IV. IV infusion should be over 15-30 minutes or as a slow bolus.
* Cefriaxone is a common cause of biliary pseudolithiasis (sludge) due to precipitation with calcium. This is usually asymptomatic and resolves after discontinuation of the drug.
* In neonates, cefriaxone is contraindicated with calcium-containing IV solutions and parenteral nutrition due to the risk of fatal precipitation.
**Disclaimer:** This information is intended for clinical use and does not replace professional medical advice. Always consult the official prescribing information and relevant guidelines for complete and up-to-date details before making any treatment decisions.
