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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 has a long half-life, allowing for once or twice-daily dosing.
## Primary Indications
* Pneumonia
* Meningitis
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Gonorrhea
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe Infections:** Up to 4 grams IV daily, divided every 12 hours.
* **Surgical Prophylaxis:** 1-2 grams IV or IM 30-60 minutes before incision.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. (1 gram IM for disseminated gonococcal infections).
## Pediatric Dosing
Dosing varies significantly based on indication and weight. Specific protocols should be followed.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (maximum 4 grams/day).
* **Other serious infections:** 50-100 mg/kg/day IV divided every 12 to 24 hours (maximum 4 grams/day).
* **Neonates (0-14 days):** 25-50 mg/kg/day IV divided every 24 hours.
## Dose Adjustments
No dose adjustment is typically needed for renal or hepatic impairment due to its biliary excretion and minimal renal clearance. However, caution is advised in severe renal impairment, especially if concomitant hepatic impairment exists.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Concurrent use with IV calcium-containing solutions in neonates (risk of precipitates).
## Adverse Effects
* Phlebitis, pain at injection site
* Rash, pruritus
* Diarrhea, nausea, vomiting
* Eosinophilia, thrombocytosis, leukopenia
* Biliary sludge/cholelithiasis (especially with prolonged use or high doses)
* Rare: Anaphylaxis, Stevens-Johnson syndrome, Clostridioides difficile-associated diarrhea.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity when used together, though often used synergistically for severe infections. Monitor renal function.
* **Warfarin:** Ceftriaxone may decrease the efficacy of warfarin. Monitor INR closely.
* **Calcium-containing solutions (IV):** Contraindicated in neonates due to risk of precipitation in lungs and kidneys. Generally avoid concurrent IV administration in adults, though Y-site compatibility may exist for intermittent infusions depending on formulation and timing.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (especially in severe impairment or with concurrent nephrotoxic agents).
* Complete blood count.
* Signs of hypersensitivity reactions.
* For prolonged use, consider monitoring for biliary sludge.
## Clinical Pearls
* Can be administered IM without lidocaine in adults, though lidocaine may be added for comfort.
* Ensure adequate hydration when administering.
* In patients with severe renal impairment and hepatic disease, the AUC may increase, but routine dose reduction is not typically required.
* Discontinue if hypersensitivity occurs.
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_Always consult the most current prescribing information and institutional guidelines for definitive dosing and administration details._
