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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 intravenously or intramuscularly.
## Primary Indications
* Bacterial meningitis
* Pneumonia
* Skin and skin structure infections
* Urinary tract infections
* Sepsis
* Gonorrhea (uncomplicated)
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections:** May increase to 4 grams IV daily, administered as 2 grams every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical prophylaxis:** 2 grams IV 30-60 minutes prior to incision.
* **Gonorrhea (uncomplicated):** 500 mg IM single dose (1 gram for disseminated gonococcal infection).
Dosing frequency and duration depend on the type and severity of infection and should be guided by clinical response and local protocols.
## Pediatric Dosing
Dosing in neonates and children should be based on weight and is often determined by institutional guidelines.
* **Neonates (< 7 days):** 25-50 mg/kg IV every 24 hours.
* **Neonates (7-28 days):** 50-100 mg/kg IV every 24 hours.
* **Children > 28 days:**
* **General infections:** 50-100 mg/kg/day IV or IM divided every 12-24 hours.
* **Meningitis:** 80-100 mg/kg/day IV divided every 12-24 hours.
* Maximum daily dose generally not to exceed 4 grams.
**Note:** Ceftriaxone is generally *not* recommended in neonates (<28 days) receiving calcium-containing solutions or infusions due to the risk of precipitation.
## Dose Adjustments
No dose adjustment is generally required for renal impairment. However, in severe renal impairment with concomitant hepatic impairment, caution and potential dose reduction may be considered.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates (≤ 28 days of age) who are receiving or expected to receive intravenous calcium-containing solutions, including continuous IV infusions of parenteral nutrition.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, phlebitis (at injection site).
* **Serious:**
* Hypersensitivity reactions (anaphylaxis)
* Clostridioides difficile-associated diarrhea
* Biliary pseudolithiasis (especially in children)
* Hemolytic anemia
* Agranulocytosis
* Seizures (rare)
## Key Drug Interactions
* **Calcium-containing solutions/products:** Risk of precipitation in the lungs and kidneys, especially in neonates. Avoid coadministration.
* **Aminoglycosides:** Potential for increased nephrotoxicity when used together.
* **Warfarin:** Ceftriaxone may alter the effect of warfarin. Monitor INR.
* **Probenecid:** May increase and prolong ceftriaxone serum levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for development of diarrhea; assess for C. difficile infection if indicated.
* Monitor renal and hepatic function, especially in patients with pre-existing impairment.
* Monitor for signs of phlebitis at the IV administration site.
* In neonates, monitor for signs of precipitation.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing in many indications, improving patient compliance.
* It is a preferred agent for community-acquired pneumonia and meningitis.
* It is the recommended treatment for uncomplicated gonorrhea.
* When reconstituting, use the appropriate diluent (e.g., sterile water for injection, bacteriostatic water for injection, or 1% lidocaine HCl without epinephrine for IM use). Reconstituted solutions are typically stable for 24 hours at room temperature or longer when refrigerated, depending on the diluent.
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**Disclaimer:** This information is intended for clinical use and does not replace professional judgment. Always consult the most current prescribing information and institutional guidelines for definitive dosing and management recommendations.
