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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 via intravenous (IV) or intramuscular (IM) routes.
## Primary Indications
* Complicated urinary tract infections (UTIs) including pyelonephritis
* Pneumonia (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Intra-abdominal infections
* Meningitis (bacterial)
* Gonorrhea (uncomplicated)
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1 to 2 grams IV or IM every 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours, divided into two 2-gram doses every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose. (For disseminated gonococcal infection, dose may be higher and for longer duration per local guidelines).
* **Surgical Prophylaxis:** 1 to 2 grams IV single dose, 30 to 60 minutes prior to incision.
Dosing frequency and duration are dependent on the infection type, severity, and patient response. Local protocols and infectious disease consultation are recommended for complex cases.
## Pediatric Dosing
Dosing in neonates and pediatric patients varies by age and weight, and specific indications.
* **Neonates (< 28 days):**
* **Body weight ≤ 40 kg:** 25-50 mg/kg IV or IM every 24 hours.
* **Body weight > 40 kg:** 1 gram IV or IM every 24 hours.
* **Meningitis:** 100 mg/kg IV every 24 hours.
* *Note: Avoid concomitant IV calcium-containing solutions in neonates due to risk of precipitation.*
* **Pediatric Patients (> 28 days and ≤ 40 kg):**
* **General Infections:** 50-100 mg/kg IV or IM every 24 hours.
* **Severe Infections:** Up to 150 mg/kg IV per day, not to exceed 4 grams per day, divided into two doses every 12 hours.
* **Meningitis:** 100 mg/kg IV every 12 hours.
* **Pediatric Patients (> 40 kg):** Dosing generally follows adult recommendations.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is necessary in adults with renal impairment, as ceftriaxone is primarily eliminated by non-renal routes (biliary excretion). However, in severe renal failure with concurrent hepatic dysfunction, consider dose reduction.
* **Hepatic Impairment:** No dose adjustment is generally needed. In severe hepatic impairment, consider the possibility of reduced biliary excretion.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Use in neonates (less than 28 days old) receiving IV calcium-containing solutions or infusions.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, injection site pain/phlebitis.
Less Common/Serious:
* Biliary sludge and gallstone formation (especially with prolonged therapy in children)
* Pseudomembranous colitis
* Eosinophilia, leukopenia, thrombocytopenia, hemolytic anemia
* Renal impairment
* Anaphylaxis
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity; monitor renal function.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin; monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Avoid coadministration, especially IV, in neonates due to risk of precipitation.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function, especially in patients with pre-existing impairment or on concurrent nephrotoxic agents.
* Monitor for signs of hypersensitivity reactions.
* Consider monitoring for biliary sludge with prolonged therapy, particularly in pediatric patients.
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in adults, but lidocaine may be used for IM administration in children to reduce pain.
* Ceftriaxone is highly protein-bound.
* Due to its long half-life, once-daily dosing is often feasible for many indications.
* Discontinuation of breastfeeding is not typically required when ceftriaxone is administered to the mother.
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*Please verify current prescribing information with the latest official product monograph or consult with a pharmacist or physician before initiating or modifying therapy.*
