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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 intravenously or intramuscularly.
## Primary Indications
* Complicated urinary tract infections (UTIs) and pyelonephritis
* Community-acquired pneumonia (CAP)
* Hospital-acquired pneumonia (HAP)
* Acute bacterial meningitis (in patients older than 6 weeks)
* Complicated intra-abdominal infections
* Bacterial sepsis
* Uncomplicated gonorrhea
* Syphilis
* Prophylaxis for surgical procedures
## Adult Dosing
* **General Infections:** 1 to 2 grams (g) every 12 to 24 hours.
* **Severe Infections:** Doses may be increased up to 4 g every 24 hours.
* **Uncomplicated Gonorrhea:** 500 milligrams (mg) intramuscularly (IM) as a single dose. For disseminated gonococcal infection, 1 g IM or IV every 24 hours for 7 days.
* **Syphilis:** 1 g to 2 g IM or IV every 24 hours for 10 to 14 days (duration varies by stage).
* **Surgical Prophylaxis:** 1 g to 2 g IV administered 30 to 120 minutes prior to surgical incision.
## Pediatric Dosing
* **Patients older than 6 weeks:** 50 to 100 mg/kg/day IV or IM divided every 12 to 24 hours.
* **Severe Infections:** Doses may be increased up to 120 mg/kg/day, not to exceed 4 g/day.
* **Bacterial Meningitis:** 100 mg/kg/day IV divided every 12 to 24 hours. A dose of 100 mg/kg once daily (max 4 g) can be considered for documented Neisseria meningitidis, Haemophilus influenzae type b, or Streptococcus pneumoniae meningitis after 4 days of treatment.
* **Neonates (0-2 weeks):** 25-50 mg/kg/day IV divided every 24 hours. (Higher doses may be used in specific severe infections, but caution is advised due to risk of kernicterus).
*Note: Dosing for specific indications and patient populations may vary based on local protocols and clinical guidelines.*
## Dose Adjustments
No dose adjustment is generally required for renal impairment. However, caution and monitoring are advised in severe renal impairment.
## Contraindications
* Hypersensitivity to cefriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (birth to 28 days) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, phlebitis at injection site, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea (CDAD), biliary sludge or pseudolithiasis, renal dysfunction, hepatic dysfunction, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Probenecid:** May increase and prolong cefriaxone serum concentrations.
* **Aminoglycosides:** Increased risk of nephrotoxicity when used together, particularly in severe infections.
* **Warfarin:** May decrease INR; monitor INR closely.
* **Calcium-containing solutions/products:** Risk of precipitation, especially in neonates. Do not mix or administer cefriaxone simultaneously with calcium-containing solutions via the same IV line.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for diarrhea and signs of CDAD.
* Monitor renal and hepatic function, particularly with prolonged therapy or in patients with pre-existing impairment.
* Monitor complete blood counts (CBC) and liver function tests (LFTs).
* Monitor coagulation parameters if patient is on anticoagulants or has other risk factors.
* For neonates, monitor for signs of kernicterus.
## Clinical Pearls
* Cefriaxone is highly protein-bound, which may contribute to its long half-life and allows for once or twice daily dosing.
* When administered IM, it is often reconstituted with 1% lidocaine HCl to minimize injection site pain. However, lidocaine should not be used for IV administration or in pediatric patients where lidocaine is contraindicated.
* Biliary sludging or pseudolithiasis can occur, especially with prolonged or high-dose therapy. This is usually transient and asymptomatic, but caution is advised in patients with biliary tract disease.
* Cefriaxone is a treatment of choice for disseminated gonococcal infections and neurosyphilis.
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*Disclaimer: This information is intended for clinical professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
