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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
* **Bacterial infections:** Including lower respiratory tract infections, skin and soft tissue infections, urinary tract infections, bone and joint infections, meningitis, gonorrhea, and surgical prophylaxis.
## Adult Dosing
* **General infections:** 1-2 grams (g) intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe infections:** Up to 4 grams IV every 24 hours.
* **Surgical prophylaxis:** 1-2 g IV 30-60 minutes before incision.
* **Uncomplicated gonorrhea:** 500 milligrams (mg) IM as a single dose. (Reduce to 250 mg for patients < 150 kg).
Dosing for specific indications like meningitis or severe infections may vary based on institutional protocols and pathogen susceptibility.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day. Avoid concurrent IV calcium-containing solutions.
* **Neonates (15-28 days):** 50 mg/kg IV every 12-24 hours, depending on severity. Avoid concurrent IV calcium-containing solutions.
* **Children > 15 days:**
* **Uncomplicated infections:** 50-75 mg/kg IV or IM every 24 hours (maximum 2 g/day).
* **Severe infections (e.g., meningitis):** 80-100 mg/kg IV every 24 hours (maximum 4 g/day). Dosing for meningitis may be higher, up to 100 mg/kg/day divided every 12 hours, per local guidelines.
## Dose Adjustments
* **Renal impairment:** No dose adjustment is typically needed in adults with renal impairment unless hepatic function is also severely impaired.
* **Hepatic impairment:** No dose adjustment is typically needed.
* **Renal and Hepatic impairment:** Monitor serum concentrations if severe.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (≤ 41 weeks postmenstrual age) receiving IV calcium-containing solutions or undergoing continuous infusion of calcium-containing fluids.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis at the injection site, eosinophilia, thrombocytosis.
* **Serious:** Clostridioides difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), biliary sludging, kernicterus in neonates, hematologic effects (leukopenia, hemolytic anemia, thrombocytopenia).
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity and ototoxicity.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Oral anticoagulants:** May enhance the effect of oral anticoagulants.
* **Calcium-containing IV solutions:** Contraindicated in neonates. There is a risk of precipitation in IV lines in adults and children if mixed or administered simultaneously. Separate administration by at least 48 hours or use incompatible IV tubing.
## Monitoring
* **Renal and hepatic function:** Especially with prolonged therapy or in patients with pre-existing impairment.
* **Blood counts:** Particularly if prolonged therapy is expected or if signs of hematologic adverse effects occur.
* **Signs and symptoms of infection:** To assess therapeutic response.
* **Signs and symptoms of C. difficile infection.**
## Clinical Pearls
* Ceftriaxone is eliminated renally and hepatically, allowing for flexible dosing in renal or hepatic impairment alone.
* The risk of biliary sludging is higher in neonates, and the drug should be used cautiously in this population.
* When reconstituting, use appropriate diluents (e.g., sterile water for injection, bacteriostatic water for injection, 0.9% sodium chloride).
* Do not mix ceftriaxone with calcium-containing solutions in the same IV line.
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*Please verify the current prescribing information and institutional protocols for complete dosing and safety details before use.*
