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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* **Infections:** Bacterial meningitis, community-acquired pneumonia, hospital-acquired pneumonia, complicated skin and soft tissue infections, complicated intra-abdominal infections, acute pelvic inflammatory disease, uncomplicated gonorrhea, and febrile neutropenia.
* **Prophylaxis:** Surgical site infection prophylaxis.
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours.
* **Serious Infections:** Up to 4 grams IV per day (typically given as 2 grams every 12 hours).
* **Meningitis:** 2 grams IV every 12 hours.
* **Gonorrhea (uncomplicated):** 500 mg IM once.
* **Surgical Prophylaxis:** 1-2 grams IV within 2 hours before surgery.
Maximum dose: 4 grams per day.
## Pediatric Dosing
Dosing is based on indication and weight. Doses should not exceed the adult maximum of 4 grams per day.
* **General Infections (≥ 1 month):** 50-100 mg/kg/day IV or IM divided every 12 or 24 hours.
* **Serious Infections (≥ 1 month):** Up to 100 mg/kg/day IV or IM divided every 12 hours.
* **Meningitis (≥ 1 month):** 100 mg/kg/day IV divided every 12 hours.
* **Neonates (0-14 days):** 25-50 mg/kg/day IV or IM once daily.
* **Neonates (15-30 days) or premature neonates:** 50 mg/kg/day IV or IM divided every 12 or 24 hours.
*Note: Specific pediatric dosing for certain indications may vary based on local protocols and guidelines.*
## Dose Adjustments
* **Renal Impairment:** No dose adjustment typically needed due to significant hepatic excretion. However, in severe renal impairment (CrCl < 10 mL/min) and hepatic impairment, the dose may need to be reduced.
* **Hepatic Impairment:** No dose adjustment typically needed due to significant renal excretion. However, in severe hepatic impairment and renal impairment, the dose may need to be reduced.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates (≤ 41 weeks post-menstrual age) receiving IV calcium-containing solutions or intermittent infusions due to risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, eosinophilia, thrombocytosis, elevated liver enzymes.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludge or pseudolithiasis (especially in neonates and prolonged use), anaphylaxis, Stevens-Johnson syndrome, neutropenia, hemolytic anemia.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity, though not clearly demonstrated with ceftriaxone.
* **Oral Contraceptives:** May decrease efficacy.
* **Probenecid:** May increase ceftriaxone levels.
* **Warfarin:** May alter INR.
* **Calcium-containing solutions:** **Contraindicated in neonates (≤ 41 weeks post-menstrual age) receiving IV ceftriaxone.** Separate administration by at least 48 hours if both are required. For adults, the risk of precipitation is less clear but should be avoided.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea and assess for *C. difficile* infection.
* Monitor liver function tests and complete blood counts, especially with prolonged therapy.
* Monitor for signs of biliary sludge formation with prolonged therapy, particularly in pediatric patients.
## Clinical Pearls
* Ceftriaxone is often used as empiric therapy for serious infections due to its broad spectrum.
* It has a long half-life, allowing for once or twice daily dosing.
* For IM administration, reconstitute with sterile water for injection or 1% lidocaine HCl solution (if lidocaine is used, do not administer IV).
* For IV administration, reconstitute with sterile water for injection or dextrose 5% or 0.9% sodium chloride solutions. Administer as a slow IV infusion over 30 minutes or as an IV bolus over 2-4 minutes.
* Do not mix or co-administer ceftriaxone with calcium-containing solutions in any patient, especially neonates, due to the risk of fatal precipitation.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for the most up-to-date and comprehensive details before making any clinical decisions.*
