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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 intravenously or intramuscularly.
### Primary Indications
* **Serious bacterial infections:** Pneumonia, meningitis, sepsis, gonorrhea, Lyme disease (early disseminated), surgical prophylaxis.
* **Community-acquired pneumonia (CAP):** Often a first-line agent.
* **Meningitis:** Including bacterial meningitis.
* **Pelvic inflammatory disease (PID):** Often in combination with other agents.
* **Uncomplicated gonorrhea:** Single-dose treatment.
### Adult Dosing
* **General infections:** 1-2 grams IV/IM every 24 hours.
* **Severe infections:** Up to 4 grams IV per day, divided every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes prior to incision.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose.
* **Disseminated gonococcal infection:** 1 gram IV/IM every 24 hours for 7 days.
* **Lyme disease (early disseminated):** 2 grams IV every 24 hours for 14-21 days.
### Pediatric Dosing
* **Neonate (0-14 days):** 25-50 mg/kg IV/IM every 24 hours. Avoid in hyperbilirubinemic neonates.
* **Neonate (>14 days) and Children:** 50-100 mg/kg/day IV/IM divided every 12-24 hours.
* **Severe infections/Meningitis:** Up to 100 mg/kg/day IV, not to exceed 4 grams per day, divided every 12 hours.
### Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed due to significant hepatic excretion. However, monitor renal function.
* **Hepatic Impairment:** No dose adjustment is typically needed due to significant renal excretion. However, monitor hepatic function.
* **Renal and Hepatic Impairment:** Dose reduction may be considered in severe combined impairment, but data is limited.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving calcium-containing intravenous solutions (risk of precipitation).
### Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, injection site reactions (pain, phlebitis).
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary pseudolithiasis (sludge formation), eosinophilia, thrombocytopenia, leukopenia, hemolytic anemia.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, though synergistic activity may occur in some infections.
* **Warfarin:** Ceftriaxone may potentiate the effect of warfarin; monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of precipitation in lungs and kidneys.
### Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea, particularly C. difficile infection.
* Monitor complete blood count (CBC) and liver/renal function tests periodically during prolonged therapy.
* Monitor for signs of biliary sludge formation with prolonged use.
### Clinical Pearls
* Ceftriaxone is a common choice for empirical treatment of serious bacterial infections due to its broad spectrum and convenient dosing interval.
* For IM administration, reconstitute with lidocaine hydrochloride (without epinephrine) to minimize pain.
* Do not mix ceftriaxone with calcium-containing solutions or other diluents containing calcium.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and institutional protocols for complete and up-to-date guidance.*
