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## Cefriaxone
### 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
* Skin and soft tissue infections
* Pneumonia (community-acquired and hospital-acquired)
* Urinary tract infections
* Meningitis (bacterial)
* Sepsis
* Gonorrhea
* Lyme disease (early and late disseminated)
* Surgical prophylaxis
### Adult Dosing
* **General Infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours, typically given as 2 grams every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1 gram IV or IM 30-60 minutes before incision. For prolonged procedures (>4 hours) or specific procedures (e.g., colorectal), repeat doses may be administered.
* **Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infection, 1 gram IV or IM every 24 hours for 7 days.
### Pediatric Dosing
* **Neonates (< 7 days):** 25-50 mg/kg IV or IM every 24 hours. Avoid concurrent IV calcium in neonates.
* **Infants and Children (> 7 days to 12 years):** 50-100 mg/kg IV or IM every 24 hours. Doses may be divided every 12 hours for severe infections. Maximum daily dose: 4 grams.
* **Meningitis (Pediatric):** 100 mg/kg IV every 24 hours, typically given as 50 mg/kg every 12 hours. Maximum daily dose: 4 grams.
### Dose Adjustments
No dose adjustment is typically required in patients with renal or hepatic impairment. However, caution and close monitoring are advised.
### Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates with hyperbilirubinemia, particularly premature infants, due to risk of kernicterus.
* Concurrent IV administration of ceftriaxone and calcium-containing solutions or products in neonates.
### Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge or pseudolithiasis, renal precipitation (rare, particularly in neonates), hemolytic anemia.
### Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity. Monitor renal function closely.
* **Warfarin:** Ceftriaxone may alter the INR. Monitor INR closely and adjust warfarin dose as needed.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Calcium-containing solutions:** Avoid concurrent administration, especially in neonates, due to risk of precipitation in lungs and kidneys. Separate administration by at least 48 hours if both are necessary.
### Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (especially with prolonged therapy or in those with pre-existing dysfunction).
* Electrolytes.
* Signs of hypersensitivity reactions.
* Stool for C. difficile if diarrhea develops.
### Clinical Pearls
* Ceftriaxone can be administered IM without lidocaine in adults, but lidocaine may be used for dilution to reduce injection site pain.
* Biliary sludge formation is a known, often asymptomatic, side effect. It typically resolves after discontinuation of the drug.
* Due to its long half-life, once-daily dosing is convenient.
* For Lyme disease, treatment duration varies based on stage and presentation (e.g., 14-28 days).
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local institutional protocols for definitive guidance.*
