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# Cefriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative organisms.
## Primary Indications
* Treatment of serious infections caused by susceptible microorganisms, including:
* Bacterial meningitis
* Pneumonia (community-acquired, hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Septicemia
* Gonorrhea (uncomplicated)
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe Infections/Meningitis:** 2 grams IV every 12 hours (maximum 4 grams per day).
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (1 gram IM if >150 kg).
* **Surgical Prophylaxis:** 1 to 2 grams IV 30-60 minutes prior to incision.
Dosing for specific indications and durations should be guided by local protocols and susceptibility patterns.
## Pediatric Dosing
* **Neonates (< 2 weeks):** 25-50 mg/kg IV every 24 hours. *Do not exceed 50 mg/kg/day.*
* **Neonates (2-4 weeks):** 50 mg/kg IV every 24 hours. *Do not exceed 50 mg/kg/day.*
* **Infants and Children (> 4 weeks):**
* **General Infections:** 50-100 mg/kg IV or IM every 24 hours.
* **Severe Infections/Meningitis:** 80-100 mg/kg IV every 12-24 hours (maximum 4 grams per day).
Dosing for pediatric patients should be determined in consultation with pediatric infectious disease specialists, especially for neonates and critically ill children.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed in adults with moderate to severe renal impairment due to extensive hepatic metabolism and biliary excretion. However, monitor clinical response. In patients with both hepatic and renal dysfunction, caution is advised.
* **Hepatic Impairment:** No dose adjustment is typically needed.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than or equal to 28 days of age) receiving IV calcium-containing solutions or infusions, due to the risk of ceftriaxone-calcium precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, injection site reactions (pain, phlebitis), eosinophilia, thrombocytosis.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), hemolytic anemia, biliary sludge/cholelithiasis, pancreatitis (rare, more common in children), renal failure.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Probenecid:** May increase and prolong ceftriaxone serum concentrations.
* **Warfarin:** May alter INR. Monitor INR closely.
* **Calcium-containing solutions:** Contraindicated in neonates (see Contraindications).
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea; assess for *C. difficile* infection if suspected.
* Monitor renal and hepatic function, especially in patients with pre-existing organ dysfunction or those receiving concurrent nephrotoxic agents.
* Monitor INR in patients receiving warfarin.
* Monitor for signs of therapeutic response (e.g., fever resolution, WBC count normalization, symptom improvement).
## Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in adults, but lidocaine may be used to reduce injection pain.
* Avoid concurrent use of ceftriaxone and calcium-containing solutions in all patients to minimize the risk of precipitation, especially in neonates.
* Ceftriaxone is highly protein-bound; this can affect interpretation of certain lab tests (e.g., albumin).
* Biliary pseudolithiasis (sludge) is a common, usually asymptomatic, finding and typically resolves after discontinuation of ceftriaxone.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before administering any medication.*
