Please check your internet connection and try again.
# 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
* Lower respiratory tract infections
* Meningitis
* Bone and joint infections
* Intra-abdominal infections
* Skin and skin structure infections
* Urinary tract infections
* Gonorrhea
* Syphilis
* Prophylaxis for surgical site infections
## Adult Dosing
* **General:** 1 to 2 grams (g) every 12 to 24 hours.
* **Severe infections:** Up to 4 grams (g) every 24 hours, divided into two doses.
* **Gonorrhea:** 500 mg intramuscularly (IM) as a single dose. For disseminated gonococcal infection, 1 g IV/IM every 24 hours for 7 days.
* **Syphilis:** Primary, secondary, and early latent: 2.4 g IM once a week for 3 weeks. Late latent and neurosyphilis: 2.4 g IM once a week for 4 weeks. Dosing for neurosyphilis may differ based on specific clinical guidelines.
* **Surgical prophylaxis:** 1 to 2 g IV 30 to 60 minutes prior to incision.
## Pediatric Dosing
Dosing varies significantly by indication and age. Consult specific pediatric infectious disease guidelines. General recommendations include:
* **Neonates (< 7 days):** 25-50 mg/kg IV every 24 hours.
* **Older Infants and Children:** 50-100 mg/kg/day IV/IM divided every 12 to 24 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours, up to a maximum of 4 g/day.
* **Maximum pediatric dose:** Generally capped at 2 g per dose, but higher doses (up to 4 g/day) may be used for severe infections or specific indications like meningitis.
## Dose Adjustments
* **Renal impairment:** No dose adjustment is typically needed. Ceftriaxone is extensively eliminated by the liver and kidneys; however, studies have not shown a need for adjustment in renal impairment alone.
* **Hepatic impairment:** No dose adjustment is typically needed.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (< 41 weeks post-conceptual age) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* Phlebitis, pain, or tenderness at injection site.
* Rash, pruritus.
* Diarrhea, nausea, vomiting.
* Eosinophilia, thrombocytosis, leukopenia.
* Biliary pseudolithiasis (especially in neonates and children).
* Rarely: Stevens-Johnson syndrome, anaphylaxis.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, though often used concurrently for synergy. Monitor renal function.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions (IV):** Contraindicated in neonates due to precipitation risk in lungs and kidneys. In adults, separate administration by at least 48 hours if using the same IV line.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function, especially with prolonged therapy or in patients with pre-existing organ dysfunction.
* Complete blood count (CBC).
* Injection site for signs of phlebitis.
## 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, meningitis, and disseminated gonococcal infections.
* Biliary sludging can occur, especially in neonates and children, and is usually reversible upon discontinuation.
***
*Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always verify the most current prescribing information with official drug references and institutional protocols.*
