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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation, broad-spectrum cephalosporin antibiotic. It exhibits long plasma half-life (approx. 8 hours), allowing for once-daily dosing. It is excreted by both hepatic (40%) and renal (60%) pathways.
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Gonococcal infections (GC)
* Surgical prophylaxis
* Complicated intra-abdominal infections
* Pyelonephritis and complicated urinary tract infections
## Adult Dosing
* **Standard Infections:** 1–2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours (may start with 10 mg/kg loading dose).
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (if weight <150 kg; 1 g if ≥150 kg).
* **Max Dose:** 4 g/day.
## Pediatric Dosing
* **General Infections:** 50–75 mg/kg/day IV/IM divided every 12–24 hours (Max 2 g/day).
* **Meningitis:** 100 mg/kg/day (Max 4 g/day) divided every 12 hours.
* **Neonates:** 50 mg/kg once daily (avoid in hyperbilirubinemia).
## Dose Adjustments
* **Renal Impairment:** No initial dose adjustment required in patients with CrCl <10 mL/min, provided the dose does not exceed 2 g/day.
* **Hepatic Impairment:** No adjustment required if renal function is intact; monitor liver enzymes if significant hepatic impairment is present.
* **Combined Impairment:** Reduce dose in severe cases; monitor serum concentrations if available.
## Contraindications
* **Hypersensitivity:** Known allergy to cephalosporins.
* **Neonates (<28 days):** Concurrent use with calcium-containing IV solutions (risk of fatal ceftriaxone-calcium salt precipitation in lungs/kidneys).
* **Hyperbilirubinemia:** Avoid in neonates (especially premature) with jaundice as ceftriaxone displaces bilirubin from albumin.
## Adverse Effects
* **Common:** Injection site pain/induration, diarrhea (including *C. difficile* risk), rash.
* **Serious:** Biliary sludging/pseudocholelithiasis (long-term use), eosinophilia, thrombocytosis, anaphylaxis, hemolytic anemia.
## Key Drug Interactions
* **Calcium-containing products (e.g., Ringer's lactate):** Fatal precipitation; avoid all calcium-containing IV solutions in neonates. In adults, use separate lines and flush rigorously.
* **Aminoglycosides:** Potential synergistic activity but risk of nephrotoxicity (monitor renal function).
* **Oral Contraceptives:** Potential risk of decreased efficacy (limited evidence, but use barrier backup during therapy).
## Monitoring
* **Baseline:** Baseline hepatic/renal function.
* **Ongoing:** Monitor for signs of *C. difficile* (diarrhea), biliary symptoms (abdominal pain/RUQ discomfort), and improvement in site/source of infection.
## Clinical Pearls
* **Biliary Sludging:** Highly reversible after discontinuation; usually seen in patients receiving prolonged therapy.
* **Spectrum:** Excellent against *Streptococcus pneumoniae*, *Haemophilus influenzae*, and *Neisseria gonorrhoeae*. Generally lacks activity against *Enterococcus* species and *Pseudomonas aeruginosa*.
* **Compatibility:** Do not mix with calcium-containing IV lines. Compatibility is drug-specific; always verify IV compatibility charts.
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**Educational Disclaimer:** This summary is for informational purposes for healthcare professionals. Dosing may vary based on local institutional protocols, severity of infection, and site-specific susceptibility patterns. Always verify current prescribing information in a standard formulary or via institutional guidelines before administration.
