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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation, broad-spectrum cephalosporin antibiotic. It possesses a long elimination half-life (approx. 8 hours), allowing for once-daily dosing. It is highly protein-bound and undergoes dual biliary and renal excretion.
## Primary Indications
* Community-acquired pneumonia
* Meningitis (often combined with vancomycin)
* Complicated intra-abdominal infections
* Gonorrhea (uncomplicated)
* Pyelonephritis and urinary tract infections
* Endocarditis
* Prophylaxis in surgical procedures
## Adult Dosing
* **General Infections:** 1 to 2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (patients <150 kg); 1 g IM for patients ≥150 kg.
* **Maximum Dose:** Generally 4 g/day for severe infections.
## Pediatric Dosing
* **General Infections:** 50 to 75 mg/kg IV/IM once daily (Max: 2 g/day).
* **Meningitis:** 100 mg/kg/day IV divided every 12–24 hours (Max: 4 g/day).
* **Neonates:** Not recommended in neonates ≤28 days if they require calcium-containing IV solutions due to risk of precipitation. 50 mg/kg once daily is standard for non-neonatal infants.
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment necessary for mild-to-moderate renal impairment.
* **Hepatic Impairment:** No adjustment required; however, monitor for biliary sludge in severe hepatic dysfunction.
* **Combined Renal/Hepatic Failure:** Monitor serum concentrations or use with caution; max dose should not exceed 2 g/day.
## Contraindications
* Hypersensitivity to cephalosporins or severe hypersensitivity to penicillins.
* **Neonates (≤28 days):** Concurrent use with calcium-containing IV solutions (risk of ceftriaxone-calcium precipitates in lungs/kidneys).
* Hyperbilirubinemic neonates (ceftriaxone may displace bilirubin from albumin).
## Adverse Effects
* **Gastrointestinal:** Diarrhea, *Clostridioides difficile*-associated diarrhea.
* **Hematologic:** Eosinophilia, thrombocytosis, leukopenia.
* **Biliary:** Biliary sludge/pseudolithiasis (most common in pediatric patients on prolonged therapy).
* **Injection Site:** Pain, induration (when administered IM).
## Key Drug Interactions
* **Calcium-containing solutions:** Physically incompatible; avoid concurrent admin in neonates or Y-site administration in all patients.
* **Warfarin:** May enhance anticoagulant effect; monitor INR.
## Monitoring
* Monitor for signs of *C. difficile* (persistent watery diarrhea).
* Monitor renal function in prolonged therapy.
* Monitor LFTs if therapy exceeds 14 days.
* Assess for biliary symptoms (RUQ pain) if prolonged treatment is required.
## Clinical Pearls
* **IM Administration:** Use 1% lidocaine for reconstitution to reduce injection site pain.
* **Dosing Variation:** Always verify doses against institutional guidelines (e.g., Sanford Guide or local antibiogram), as specific durations and dosing tiers for severe sepsis or endocarditis vary by facility policy.
* **Spectrum:** Excellent coverage against *Streptococcus pneumoniae*, *Haemophilus influenzae*, and *Neisseria* species; lacks activity against *Enterococcus* species and MRSA.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical dosing, policies, and contraindications may change based on updated guidelines and regional resistance patterns. Always verify current prescribing information via institutional resources or official FDA-approved labels before administering medication.
