Please check your internet connection and try again.
# 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
* Community-acquired pneumonia
* Skin and skin structure infections
* Urinary tract infections
* Meningitis (bacterial)
* Sepsis
* Gonorrhea
* Pelvic inflammatory disease
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours, typically divided as 2 grams every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM single dose.
* **Surgical prophylaxis:** 1-2 grams IV/IM single dose, 30-60 minutes prior to incision.
Dosing for specific indications may vary based on local guidelines and institutional protocols.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Avoid IV use with hyperbilirubinemia due to risk of bilirubin encephalopathy.
* **Neonates (15-28 days):** 50 mg/kg IV/IM every 24 hours.
* **Children > 15 days and < 12 years or weighing < 50 kg:** 50-100 mg/kg IV/IM per day, divided every 12-24 hours.
* **Children ≥ 12 years or weighing ≥ 50 kg:** Dosing as per adult recommendations.
* **Meningitis (pediatric):** 100 mg/kg IV per day, divided every 12 hours (maximum 4 grams/day).
Dosing should be guided by institutional protocols and clinical response.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment. However, in severe renal impairment (CrCl < 10 mL/min), the daily dose can be halved if the usual dose is 2 grams or more.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates (≤ 28 days) receiving IV ceftriaxone concurrently with calcium-containing solutions or products due to risk of precipitate formation.
## Adverse Effects
Common: rash, diarrhea, nausea, vomiting, phlebitis at injection site.
Serious: hypersensitivity reactions (anaphylaxis), Clostridioides difficile-associated diarrhea, biliary sludge or pseudolithiasis, hematologic changes (eosinophilia, leukopenia, thrombocytopenia), renal or hepatic abnormalities.
## Key Drug Interactions
* **Calcium-containing solutions:** Risk of fatal precipitation in neonates. Avoid concurrent IV administration.
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may alter the anticoagulant effect of warfarin; monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone levels.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Hematologic parameters.
* Signs of hypersensitivity.
* Biliary symptoms (abdominal pain, jaundice) in patients on prolonged therapy.
## Clinical Pearls
* Ceftriaxone is highly protein-bound.
* Do not mix or administer ceftriaxone simultaneously with calcium-containing solutions via the same IV line, especially in neonates.
* Intramuscular administration is often less painful when reconstituted with 1% lidocaine HCl (without epinephrine).
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and institutional guidelines for complete details before making any clinical decisions.*
