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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis. It is characterized by a long half-life, allowing for once-daily dosing, and is eliminated via both hepatic and renal pathways.
## Primary Indications
Commonly used for community-acquired pneumonia, meningitis, complicated intra-abdominal infections, skin/soft tissue infections, pyelonephritis, gonorrhea (as part of dual therapy), and prophylaxis in surgical procedures.
## Adult Dosing
* **Standard infections:** 1 to 2 grams IV/IM once daily.
* **Meningitis:** 2 grams IV every 12 hours.
* **Gonorrhea:** 500 mg IM as a single dose (for patients <150 kg; use 1g for patients ≥150 kg).
* **Maximum dose:** Typically 4 grams per day for severe infections.
## Pediatric Dosing
* **Standard infections:** 50–75 mg/kg IV/IM once daily. Maximum 2 grams/day.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours. Maximum 4 grams/day.
* **Gonorrhea (≥45 kg):** Adult dosing applies.
* **Neonates:** Avoid in neonates ≤28 days if they require calcium-containing IV solutions (risk of precipitation). Generally 50 mg/kg/day IV once daily.
## Dose Adjustments
* **Renal Impairment:** No adjustment required for mild to severe renal impairment.
* **Hepatic Impairment:** No adjustment required unless severe liver disease is present concurrently with renal impairment (monitor trough levels).
* **Dialysis:** Patients on hemodialysis generally do not require supplemental dosing.
## Contraindications
* Hypersensitivity to ceftriaxone or cephalosporin-class antibiotics.
* **Neonates (≤28 days):** Absolute contraindication if receiving calcium-containing IV products (includes TPN and Ringer's lactate) due to the risk of ceftriaxone-calcium salt precipitation in lungs and kidneys.
## Adverse Effects
* **Common:** Injection site reactions (pain), diarrhea, rash.
* **Serious:** Biliary sludge/pseudolithiasis (long-term use), Clostridioides difficile-associated diarrhea, anaphylaxis, hemolysis (rare).
## Key Drug Interactions
* **Calcium-containing products:** Potential for fatal precipitation in neonates (avoid concurrent use).
* **Warfarin:** May enhance anticoagulant effect; monitor INR.
## Monitoring
* Monitor for signs of hypersensitivity.
* Clinical resolution of infection (fever, WBC count).
* Assess for biliary sludge in patients receiving prolonged therapy.
## Clinical Pearls
* **Biliary Sludge:** Ceftriaxone is excreted in bile; biliary "pseudolithiasis" is a known phenomenon that usually resolves upon discontinuation.
* **Not for MRSA:** Ceftriaxone does not provide coverage for MRSA or *Enterococcus* species.
* **IM Injection:** When administering IM, diluting with 1% lidocaine is often standard practice to reduce injection site pain, provided there is no lidocaine allergy.
* **Local Protocols:** Hospital-specific antibiograms and institutional protocols should always be consulted for empirical therapy selections, as resistance patterns vary significantly by geography.
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*Disclaimer: This information is for educational purposes only. Always consult your institution's current prescribing guidelines, the official FDA-approved package insert, or a clinical pharmacist before prescribing or administering medication.*
