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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
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Meningitis (bacterial)
* Skin and soft tissue infections
* Urinary tract infections
* Biliary tract infections
* Septicemia
* Prophylaxis for surgical procedures
## Adult Dosing
* **General Infections:** 1 to 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).
* **Uncomplicated Gonorrhea:** 500 mg IM single dose. For disseminated gonococcal infections, 1 gram IV/IM every 24 hours for 7-10 days.
* **Meningitis:** 2 grams IV every 24 hours. Higher doses may be used in specific situations, but typically not exceeding 4 grams daily.
* **Surgical Prophylaxis:** 1 to 2 grams IV/IM 30-60 minutes before surgery.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV/IM once every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days), Infants, and Children (< 50 kg):** 50-100 mg/kg/day IV/IM divided into two doses (every 12 hours). Maximum daily dose is 2 grams.
* **Children (> 50 kg):** Dose as per adult recommendations.
* **Meningitis (Pediatric):** 100 mg/kg/day IV divided into two doses (every 12 hours). Maximum daily dose is 4 grams.
*Note: Dosing for specific pediatric indications may vary based on local protocols and organism susceptibility.*
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed in adults with impaired renal function, as ceftriaxone is largely cleared by non-renal mechanisms.
* **Hepatic Impairment:** No dose adjustment is typically needed.
* **Concomitant Renal and Hepatic Impairment:** Monitor ceftriaxone levels if severe impairment exists.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving IV calcium-containing solutions or TPN.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, rash, phlebitis at injection site, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Anaphylaxis, C. difficile-associated diarrhea, biliary sludging (especially in neonates and with prolonged therapy), renal and hepatic abnormalities, hematologic changes, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity, particularly in patients with renal impairment.
* **Warfarin:** Ceftriaxone may decrease the effectiveness of warfarin; monitor INR closely.
* **Probenecid:** May increase ceftriaxone serum levels.
* **Calcium-containing solutions (IV):** Contraindicated in neonates due to risk of precipitation. Avoid co-administration with other IV calcium-containing products.
## Monitoring
* Assess for signs and symptoms of infection.
* Monitor for adverse effects, particularly diarrhea and allergic reactions.
* Monitor renal and hepatic function, and complete blood counts, especially with prolonged therapy or in critically ill patients.
* For neonates receiving high-dose ceftriaxone, consider monitoring for biliary sludge.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in many adult indications.
* Due to its biliary excretion, ceftriaxone can cause biliary sludging, which is usually reversible upon discontinuation of the drug.
* Always ensure adequate hydration when administering ceftriaxone to minimize crystalluria.
* When reconstituting, follow manufacturer instructions carefully.
This information is intended for healthcare professionals. Always verify current prescribing information and consult with a specialist when necessary.
