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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
* Lower respiratory tract infections (e.g., community-acquired pneumonia)
* Skin and soft tissue infections
* Urinary tract infections
* Complicated intra-abdominal infections
* Bacterial meningitis (including *Neisseria meningitidis*)
* Sepsis
* Disseminated gonococcal infections
* Prophylaxis for surgical infections
### Adult Dosing
* **General infections:** 1 to 2 grams (g) IV/IM every 24 hours.
* **Severe infections:** Up to 4 grams (g) IV every 24 hours, administered as 2 g every 12 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 milligrams (mg) IM single dose.
* **Complicated gonorrhea:** 1 g IM or IV every 24 hours for 3-7 days.
* **Surgical prophylaxis:** 1 to 2 g IV 30-60 minutes prior to incision.
### Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days):** 25-50 mg/kg IV every 24 hours.
* **Infants and Children (>28 days to 12 years):**
* **General infections:** 50-100 mg/kg/day IV/IM divided every 12 or 24 hours. Maximum 2 g/day.
* **Severe infections:** Up to 100 mg/kg/day IV divided every 12 hours. Maximum 4 g/day.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours. Maximum 4 g/day.
* **Children >12 years:** Dosing as per adults.
**Note:** For pediatric meningitis, doses are often guided by specific pathogens and local protocols. Doses up to 80-100 mg/kg/day divided every 8-12 hours have been used in some severe cases.
### Dose Adjustments
No dose adjustment is typically required for renal impairment. However, in severe hepatic impairment with concomitant renal dysfunction, dosage may need consideration.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (especially premature) receiving IV calcium-containing solutions or undergoing continuous IV infusions of calcium-containing products due to the risk of precipitation in the lungs and kidneys.
### Adverse Effects
Common: Diarrhea, rash, phlebitis, pain at injection site.
Less common: Nausea, vomiting, headache, eosinophilia, thrombocytosis, leukopenia, elevated liver enzymes, renal impairment.
Rare: *Clostridioides difficile*-associated diarrhea, anaphylaxis, seizures, biliary sludging, kernicterus in neonates.
### Key Drug Interactions
* **Calcium-containing solutions:** Avoid co-administration in neonates. In adults, separate administration by at least 48 hours if IV. If IM, avoid concurrent administration.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin; monitor INR.
* **Aminoglycosides:** Potential for additive nephrotoxicity; monitor renal function.
* **Probenecid:** May increase ceftriaxone levels.
### Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of *C. difficile* infection.
* Assess injection site for phlebitis or pain.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing impairment.
* Monitor for therapeutic response (e.g., resolution of fever, signs of infection).
### Clinical Pearls
* Ceftriaxone is often a preferred agent for community-acquired pneumonia and meningitis.
* It is one of the few antibiotics that can be dosed once daily for many common infections.
* For intramuscular administration, reconstitute with the appropriate diluent (e.g., 1% lidocaine HCl solution) to minimize pain.
* Intravenous administration should be slow (2-4 minutes) or as an infusion.
* Biliary sludging is a common, usually asymptomatic, finding and typically resolves after discontinuation of the drug.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for complete details before making any treatment decisions.
