Please check your internet connection and try again.
# Cefriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative bacteria.
## Primary Indications
* **Bacterial meningitis:** Often a first-line agent for community-acquired bacterial meningitis.
* **Pneumonia:** Community-acquired and hospital-acquired pneumonia.
* **Skin and soft tissue infections:** Uncomplicated and complicated infections.
* **Urinary tract infections:** Including pyelonephritis.
* **Intra-abdominal infections:** Often in combination with other agents.
* **Sepsis and bacteremia.**
* **Gonorrhea:** Single-dose treatment for uncomplicated gonorrhea.
* **Lyme disease:** Particularly for neurological or cardiac manifestations.
## Adult Dosing
* **General infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections:** May increase to 4 grams IV every 24 hours, divided into two doses (2 grams every 12 hours).
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose. For rectal, pharyngeal, or disseminated gonococcal infection, 1 gram IM or IV every 24 hours for 7 days is recommended (though a single 1g dose may be used for disseminated).
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes prior to incision.
Dosing frequency and duration are dependent on the specific infection and clinical response, often guided by local protocols.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 125 mg/day.
* **Neonates (15-28 days):** 50 mg/kg IV every 24 hours. May increase to 75 mg/kg/day if severe infection.
* **Infants and Children (>28 days to 12 years):** 50-100 mg/kg/day IV or IM, divided into two doses (every 12 hours).
* **Severe infections (including meningitis):** Up to 100 mg/kg/day IV, not to exceed 4 grams/day.
* **Uncomplicated gonorrhea:** 125 mg IM as a single dose for patients >45 kg.
Dosing for neonates requires careful consideration of gestational and postnatal age due to potential for kernicterus.
## Dose Adjustments
No dose adjustment is typically required for hepatic impairment.
For renal impairment, dose adjustment is generally not necessary unless concurrent severe hepatic impairment is present, or in neonates. Monitor closely.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates with hyperbilirubinemia, especially those who are premature, due to risk of kernicterus.
* Concurrent IV administration with calcium-containing solutions in neonates (risk of precipitation).
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis at the injection site, eosinophilia, thrombocytosis.
* **Serious:**
* **Biliary pseudolithiasis:** Common in children, often asymptomatic.
* **Anaphylaxis:** Severe allergic reactions.
* **Clostridioides difficile-associated diarrhea.**
* **Hematologic:** Hemolytic anemia, leukopenia, neutropenia, thrombocytopenia.
* **Renal:** Interstitial nephritis.
* **Neurologic:** Seizures (rare, usually with high doses).
## Key Drug Interactions
* **Calcium-containing solutions:** Do not administer concurrently with IV calcium solutions, especially in neonates. Separate administration by at least 48 hours if both are needed.
* **Aminoglycosides:** Potential for additive nephrotoxicity. Monitor renal function closely.
* **Warfarin:** May decrease INR. Monitor INR closely and adjust warfarin dose as needed.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* **Clinical:** Monitor for signs and symptoms of infection resolution and improvement.
* **Renal and Hepatic function:** Especially with prolonged therapy or in patients with pre-existing impairment.
* **Hematologic parameters:** Particularly with prolonged or high-dose therapy.
* **Injection site:** For signs of phlebitis or local reaction.
* **INR:** If patient is on warfarin.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing in most adult indications.
* The IM route is generally less painful than IV for single-dose indications like gonorrhea.
* It readily crosses the blood-brain barrier and is a preferred agent for bacterial meningitis.
* Be aware of the potential for biliary sludge, particularly in pediatric patients, and consider alternative agents if symptoms arise or if alternatives are feasible.
* Reconstitution requires specific diluents. Always check manufacturer's recommendations.
***
*Disclaimer: This information is intended for clinical pharmacists and prescribers. It is essential to consult the most current prescribing information and relevant guidelines before making any clinical decisions. Dosing may vary based on local protocols and patient-specific factors.*
