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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative organisms. It is characterized by a long half-life, allowing for once-daily administration.
## Primary Indications
* Community-acquired pneumonia.
* Meningitis.
* Complicated intra-abdominal infections (often with metronidazole).
* Skin and skin structure infections.
* Uncomplicated gonorrhea (single dose).
* Empiric treatment of sepsis.
## Adult Dosing
* **Standard 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 (for patients <150 kg; 1 g for those ≥150 kg).
* **Maximum Dose:** 4 g/day in severe infections.
## Pediatric Dosing
* **General infections:** 50–75 mg/kg IV/IM once daily (Max: 2 g/day).
* **Meningitis:** 100 mg/kg/day IV divided every 12–24 hours (Loading dose 100 mg/kg; Max: 4 g/day).
* **Neonates:** 50 mg/kg/day once daily. Avoid in hyperbilirubinemic neonates.
## Dose Adjustments
* **Renal Impairment:** No adjustment required for CrCl ≥10 mL/min.
* **Hepatic Impairment:** No adjustment required; however, monitor levels if severe hepatic and renal impairment coexist.
## Contraindications
* Hypersensitivity to cephalosporins or severe hypersensitivity to penicillins (IgE-mediated).
* **Neonates (≤28 days):** Use is contraindicated with concurrent calcium-containing IV solutions (including TPN) due to the risk of ceftriaxone-calcium precipitates in lungs and kidneys.
## Adverse Effects
* Biliary sludge ("pseudolithiasis") and cholecystitis.
* Injection site reactions (pain/induration).
* Diarrhea, including *Clostridioides difficile*-associated diarrhea.
* Eosinophilia, thrombocytosis, or leukopenia.
## Key Drug Interactions
* **Calcium-containing products:** Do not administer via Y-site or in the same line. Flush lines thoroughly.
* **Oral Contraceptives:** May reduce efficacy; consider back-up method.
* **Vitamin K Antagonists:** May increase INR and risk of bleeding; monitor closely.
## Monitoring
* Signs of biliary obstruction (e.g., abdominal pain).
* Renal function (BUN/Cr) during prolonged therapy.
* CBC (for long-term use >10 days to monitor for leukopenia/neutropenia).
* Signs of *C. difficile* infection (unresolved diarrhea).
## Clinical Pearls
* Ceftriaxone is not active against *Enterococcus* species, *Listeria monocytogenes*, or MRSA.
* It is highly protein-bound; it displaces bilirubin from albumin, hence the contraindication in neonates with jaundice.
* For intramuscular administration, reconstitute with 1% lidocaine to reduce injection pain.
* Always consult institutional antibiograms, as susceptibility patterns vary by region and resistance to third-generation cephalosporins is rising in certain organisms (e.g., *E. coli* ESBL).
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**Disclaimer:** This information is for educational purposes only. Clinical practice guidelines change frequently based on resistance patterns and new evidence. Always verify dosing, contraindications, and drug interactions using current, peer-reviewed clinical decision-support tools (e.g., Lexicomp, UpToDate) and your local institutional protocols before prescribing.
