Please check your internet connection and try again.
# 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 biliary excretion, which typically spares dose adjustment in renal impairment.
## Primary Indications
* Community-acquired pneumonia
* Meningitis (high susceptibility to CNS penetration)
* Complicated intra-abdominal infections (usually with metronidazole)
* Gonorrhea (uncomplicated)
* Pyelonephritis and complicated urinary tract infections
* Skin and soft tissue infections
## Adult Dosing
* **General Infections:** 1–2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (if patient weight <150 kg; 1 g if ≥150 kg).
* **Maximum Dose:** 4 g/day for severe infections.
## Pediatric Dosing
* **General Infections:** 50–75 mg/kg/day IV divided every 24 hours (Max: 2 g/day).
* **Meningitis:** 100 mg/kg/day IV divided every 12–24 hours (Max: 4 g/day). Loading dose of 100 mg/kg may be used.
* **Neonates (Postnatal age >7 days):** 50 mg/kg/day once daily.
## Dose Adjustments
* **Renal Impairment:** No adjustment required for CrCl ≥10 mL/min.
* **Hepatic Impairment:** No adjustment required unless severe hepatic and renal impairment coexist (monitor serum concentrations).
* **Combined Impairment:** Reduce dose in severe combined failure.
## Contraindications
* Hypersensitivity to cephalosporins.
* **Neonates:** Concurrent use of calcium-containing IV solutions (risk of fatal ceftriaxone-calcium precipitation in lungs/kidneys). Must not use in neonates (≤28 days) receiving calcium-containing products.
* Hyperbilirubinemic neonates (ceftriaxone displaces bilirubin from albumin).
## Adverse Effects
* **Biliary Sludging/Pseudolithiasis:** Especially with high doses or prolonged therapy.
* **Gastrointestinal:** Diarrhea, *Clostridioides difficile*-associated diarrhea.
* **Hematologic:** Eosinophilia, thrombocytosis, leukopenia.
* **Local:** Injection site pain/phlebitis.
## Key Drug Interactions
* **Calcium-containing products:** Absolute contraindication in neonates; in patients >28 days, administer via separate lines and flush lines thoroughly.
* **Oral Contraceptives:** May reduce efficacy; consider barrier methods.
* **Anticoagulants:** May increase INR/risk of bleeding via vitamin K synthesis disruption in gut flora.
## Monitoring
* Monitor for signs of *C. difficile* infection (diarrhea).
* Monitor gallbladder/biliary tract for symptomatic sludge (RUQ pain, jaundice) during prolonged therapy.
* Assess for hematologic changes if therapy exceeds 10–14 days.
## Clinical Pearls
* Ceftriaxone possesses no activity against *Enterococcus* species or MRSA.
* IM injections should be reconstituted with 1% lidocaine to reduce pain, provided the patient has no history of local anesthetic allergy.
* Dosing varies significantly by institutional antibiograms and local epidemiological resistance patterns; always verify with local protocols.
***
**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and drug resistance patterns evolve. Always verify current prescribing information, dose calculations, and contraindications against the latest institutional protocols and FDA-approved labeling before administration.
