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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
* Bacterial meningitis
* Pneumonia (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections
* Intra-abdominal infections
* Gonorrhea
* Sepsis
* Prophylaxis for surgical infections
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 12 or 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Severe infections/uncomplicated gonorrhea:** 2 grams IV/IM every 24 hours.
* **Maximum daily dose:** 4 grams.
Dosing frequency and duration are dependent on the type and severity of infection and clinical response. Specific indications may have unique dosing recommendations (e.g., meningitis, gonorrhea).
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV/IM every 24 hours.
* **Neonates (>14 days) and Children:**
* **General infections:** 50-100 mg/kg IV/IM every 12 or 24 hours.
* **Meningitis:** 100 mg/kg IV every 12 hours.
* **Maximum pediatric dose:** 2 grams daily.
Dosing for neonates should not exceed the adult maximum of 2 grams daily.
## Dose Adjustments
No dose adjustment is typically required for renal impairment due to high hepatic clearance. However, in severe renal impairment without concurrent hepatic dysfunction, doses may need to be reduced or dosing interval extended, though this is debated and often not necessary.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactams.
* Neonates (birth to 28 days) receiving IV calcium-containing solutions, including continuous or intermittent infusions, due to the risk of precipitation of ceftriaxone-calcium.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, phlebitis at injection site.
Serious: *Clostridioides difficile*-associated diarrhea, anaphylaxis, biliary sludge/pseudolithiasis, eosinophilia, thrombocytosis, leukopenia, hemolytic anemia, renal and hepatic abnormalities.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity, especially with concurrent renal impairment.
* **Warfarin:** Ceftriaxone may potentiate the anticoagulant effect of warfarin.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions (IV):** Contraindicated in neonates; avoid concurrent administration in adults if possible.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function, especially with prolonged therapy or in patients with pre-existing dysfunction.
* Electrolytes.
* Complete blood count.
* Liver function tests.
* Bilirubin and ultrasound may be considered in neonates and infants for biliary monitoring.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing.
* It is often the drug of choice for community-acquired pneumonia and bacterial meningitis.
* Do not mix or administer ceftriaxone simultaneously with calcium-containing solutions, even at different IV lines or sites, due to risk of precipitate formation. Separate administration by at least 48 hours.
* For IM administration, reconstitute with 1% lidocaine HCl without epinephrine to minimize pain. Do not administer IV with lidocaine.
* Biliary pseudolithiasis can occur, particularly in children, and is usually reversible upon discontinuation of the drug.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for definitive guidance.
