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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
* Skin and skin structure infections
* Pneumonia (community-acquired and hospital-acquired)
* Urinary tract infections
* Pelvic inflammatory disease
* Bacterial meningitis
* Sepsis
* Gonorrhea
* Prophylaxis for surgical site infection
## Adult Dosing
* **General Infections:** 1 to 2 grams IV or IM every 24 hours.
* **Serious Infections:** Up 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:** 250 mg IM as a single dose.
* **Surgical Prophylaxis:** 1 to 2 grams IV within 2 hours of surgical incision.
Dosing for specific indications and durations may vary based on clinical guidelines and local protocols.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV or IM every 24 hours. Maximum 50 mg/kg per dose.
* **Neonates (15-28 days):** 50 mg/kg IV or IM every 24 hours. Maximum 50 mg/kg per dose.
* **Infants and Children (>28 days):**
* **General Infections:** 50-100 mg/kg IV or IM every 24 hours, not to exceed 2 grams/day.
* **Serious Infections:** Up to 100-120 mg/kg IV or IM every 24 hours, divided into two doses (50-60 mg/kg every 12 hours), not to exceed 4 grams/day.
* **Meningitis:** 100 mg/kg IV every 12 hours, not to exceed 4 grams/day.
Dosing in neonates should consider gestational age and postnatal age.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment. However, caution is advised in severe impairment and close monitoring is recommended.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 28 days) receiving IV calcium-containing solutions or infusions due to the risk of precipitation.
## Adverse Effects
Common: Rash, diarrhea, nausea, vomiting, phlebitis at the injection site.
Serious: Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge or pseudolithiasis (especially in neonates), eosinophilia, thrombocytosis, leukopenia.
## Key Drug Interactions
* **Aminoglycosides:** May have additive or synergistic activity but increased risk of nephrotoxicity.
* **Warfarin:** May alter INR; monitor closely.
* **Probenecid:** May increase ceftriaxone serum concentrations.
* **Calcium-containing solutions:** Contraindicated in neonates. In adults, avoid concurrent administration through the same IV line.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (especially with prolonged therapy or severe impairment).
* Complete blood count.
* Signs of hypersensitivity reactions.
* INR if patient is on warfarin.
## Clinical Pearls
* Ceftriaxone is often a preferred agent for empiric treatment of serious bacterial infections due to its broad spectrum and convenient once-daily dosing.
* Due to its long half-life, it can be administered IM without lidocaine for certain indications.
* Ceftriaxone is not recommended for use in neonates receiving calcium-containing solutions due to the risk of potentially fatal precipitation in the lungs and kidneys.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for complete and up-to-date details before prescribing or administering any medication.
