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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 intravenously or intramuscularly.
## Primary Indications
* Bacterial meningitis
* Pneumonia
* Skin and soft tissue infections
* Urinary tract infections
* Sepsis
* Gonorrhea
* Disseminated Lyme disease
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Serious Infections:** Up to 4 grams IV every 24 hours (divided into two 2-gram doses).
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose.
* **Disseminated Gonococcal Infection:** 1 gram IV or IM every 24 hours for 7 days.
* **Disseminated Lyme Disease:** 2 grams IV every 24 hours for 14 to 21 days.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV or IM every 24 hours. Maximum dose: 50 mg/kg/day.
* **Neonates (15-28 days, if low birth weight):** 25-50 mg/kg IV or IM every 24 hours. Maximum dose: 50 mg/kg/day.
* **Children (> 15 days):**
* **General Infections:** 50-100 mg/kg/day IV or IM, divided every 12 or 24 hours. Maximum dose: 2 grams/day.
* **Serious Infections:** Up to 100 mg/kg/day IV or IM, divided every 12 or 24 hours. Maximum dose: 4 grams/day.
* **Meningitis:** 100 mg/kg/day IV, divided every 12 hours. Maximum dose: 4 grams/day.
* **Uncomplicated Gonorrhea:** 125 mg IM as a single dose.
*Note: Dosing in neonates should not exceed the adult maximum of 2 grams per day. Concurrent administration with calcium-containing solutions is contraindicated in neonates.*
## Dose Adjustments
No dose adjustment is typically required in patients with hepatic impairment. In patients with severe renal impairment and hepatic dysfunction, the dose may need to be reduced.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Concurrent use with calcium-containing IV solutions in neonates (risk of precipitation).
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis, injection site pain.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludging (especially in neonates), hypersensitivity reactions (including anaphylaxis), hematologic changes (eosinophilia, leukopenia, thrombocytopenia), renal and hepatic toxicity.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may alter the effect of warfarin; monitor INR closely.
* **Probenecid:** May increase ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of fatal precipitation in lungs and kidneys.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea and assess for *C. difficile*.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing dysfunction.
* Monitor for signs of superinfection.
* In neonates, monitor for biliary sludging.
## Clinical Pearls
* Ceftriaxone is often the drug of choice for community-acquired pneumonia, meningitis, and gonorrhea.
* It can be administered IM without dilution, but reconstitution may be required for IV administration.
* Due to its long half-life, once-daily dosing is often effective.
* Ensure adequate hydration when administering ceftriaxone.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for definitive guidance.*
