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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.
### Primary Indications
* Pneumonia
* Meningitis
* Bacterial sepsis
* Urinary tract infections
* Skin and soft tissue infections
* Bone and joint infections
* Gonorrhea (uncomplicated)
* Surgical prophylaxis
### Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 24 hours. Higher doses may be needed for severe infections.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infections, 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes prior to surgical incision.
**Maximum Dose:** Generally 4 grams per day, but may be higher in specific severe infections under specialist guidance.
### Pediatric Dosing
* **Neonates (< 28 days):** 25-50 mg/kg IV every 24 hours.
* **Infants and Children (> 28 days):**
* **General Infections:** 50-100 mg/kg/day IV/IM divided every 12-24 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
**Maximum Pediatric Dose:** Generally 2 grams per day. Higher doses may be used in severe infections, particularly meningitis, up to 4 grams per day under specialist guidance.
### Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically required due to extensive hepatic and biliary excretion. However, in severe renal impairment with significant hepatic dysfunction, monitoring may be warranted.
* **Hepatic Impairment:** No dose adjustment is typically required.
### Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Hyperbilirubinemic neonates, particularly premature infants, receiving IV ceftriaxone (risk of kernicterus). Concomitant use with calcium-containing IV solutions or diluents in neonates.
### Adverse Effects
* **Common:** Diarrhea, rash, phlebitis at the injection site, eosinophilia, thrombocytosis.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), biliary sludging/precipitation (especially in neonates and with prolonged therapy), hemolytic anemia, pancreatitis.
### Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially in patients with renal dysfunction.
* **Warfarin:** May decrease the effect of warfarin, leading to increased INR. Monitor INR closely.
* **Calcium-containing IV solutions/diluents:** **Contraindicated in neonates** due to risk of precipitation. Avoid in adults if possible, especially via IV route, due to potential for precipitate formation in lungs and kidneys. If administration is necessary, separate administration times.
### Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea; assess for *C. difficile* infection if persistent or severe.
* Monitor renal and hepatic function with prolonged therapy or in patients with pre-existing dysfunction.
* In neonates, monitor bilirubin levels.
* Monitor injection site for signs of phlebitis.
### Clinical Pearls
* Ceftriaxone can be administered IV or IM. IM injections are often less painful when reconstituted with 1% lidocaine without epinephrine.
* Ceftriaxone is highly protein-bound.
* Due to its long half-life, once-daily dosing is often possible for many indications.
* Biliary sludging can occur, even in adults, and may be asymptomatic. It typically resolves after discontinuation of the drug.
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*Please verify this information with the most current prescribing information and local institutional protocols before use.*
