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# Ceftriaxone
## Overview
A third-generation cephalosporin with broad-spectrum activity against many Gram-negative and Gram-positive organisms. It possesses a long half-life (approx. 8 hours), allowing for once-daily dosing. It is excreted by both hepatic and renal routes.
## Primary Indications
* Community-acquired pneumonia (CAP)
* Meningitis (high CNS penetration)
* Gonorrhea (uncomplicated)
* Sepsis/bacteremia
* Skin and soft tissue infections
* Acute otitis media (pediatric)
* Prophylaxis prior to surgical procedures
## Adult Dosing
* **General infections:** 1–2 g IV/IM every 24 hours.
* **Severe infections (e.g., meningitis):** 2 g IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM (single dose for patients <150 kg; 1 g for ≥150 kg).
* **Max dose:** 4 g/day in severe cases.
## Pediatric Dosing
* **General infections:** 50–75 mg/kg IV/IM once daily.
* **Meningitis:** 100 mg/kg/day IV divided every 12–24 hours (Max 4 g/day).
* **Acute Otitis Media:** 50 mg/kg IM (single dose).
* **Neonates (≤ 28 days):** 50 mg/kg once daily. Avoid in hyperbilirubinemia.
## Dose Adjustments
* **Renal Impairment:** No standard adjustment required for mild to severe renal impairment.
* **Hepatic Impairment:** No standard adjustment required.
* **Combined severe renal and hepatic failure:** Do not exceed 2 g/day without monitoring serum concentrations.
## Contraindications
* Hypersensitivity to cephalosporins or known anaphylaxis to penicillins (use caution).
* **Neonates (≤ 28 days):** Concurrent use with calcium-containing IV products (risk of ceftriaxone-calcium precipitates in lungs/kidneys).
* **Preterm infants:** Contraindicated with calcium-containing solutions.
## Adverse Effects
* **Common:** Injection site pain/induration, diarrhea (including *C. difficile* risk), rash.
* **Serious:** Biliary sludging/pseudolithiasis (long-term use), hemolytic anemia, anaphylaxis, *C. difficile*-associated diarrhea.
## Key Drug Interactions
* **Calcium-containing products:** Potential for fatal precipitates; avoid co-administration in neonates (<28 days). Maintain a 48-hour gap in older patients/adults if possible.
* **Oral Contraceptives:** May reduce efficacy; backup contraception recommended during treatment.
* **Warfarin:** May enhance anticoagulant effect (monitor INR).
## Monitoring
* **Clinical:** Monitor for resolution of infection/fever.
* **Safety:** Monitor for signs of *C. difficile* (frequent stools, abdominal pain), rash, or biliary symptoms (nausea, RUQ pain).
* **Labs:** Periodic CBC (if long-term) for leukopenia or anemia.
## Clinical Pearls
* **Biliary Sludge:** Most cases are reversible upon discontinuation.
* **Stability:** Once reconstituted, stability varies; verify hospital protocol/manufacturer expiration post-reconstitution.
* **Site injection:** IM injection is often painful; reconstitution with 1% lidocaine (not for IV use) is frequently utilized to improve patient comfort.
* **Dosing protocol:** Specific institutional protocols may prioritize different doses for empiric treatment; always consult local antibiogram or infectious disease guidelines.
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**Educational Disclaimer:** This summary is for informational purposes only and does not constitute medical advice. Clinical protocols vary; always verify current prescribing information, institutional guidelines, and patient-specific factors via professional drug databases or a clinical pharmacist before administration.
