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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis. It exhibits a long half-life (approx. 8 hours), allowing for once-daily dosing. It is distributed widely, including into the cerebrospinal fluid, and is primarily eliminated by dual biliary and renal excretion.
## Primary Indications
* Community-acquired pneumonia
* Meningitis (used with vancomycin)
* Complicated intra-abdominal infections
* Gonorrhea (uncomplicated)
* Pyelonephritis and complicated urinary tract infections
* Skin and soft tissue infections
* Meningococcal prophylaxis
## Adult Dosing
* **Standard infections:** 1–2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM (single dose) for patients < 150 kg; 1 g IM for patients ≥ 150 kg.
* **Maximum dose:** Typically 4 g/day for severe infections.
## Pediatric Dosing
* **Standard infections:** 50–75 mg/kg/day IV/IM divided q12h-q24h (Max: 2 g/day).
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (Max: 4 g/day).
* **Neonates (postnatal age ≤ 28 days):** 50 mg/kg/day once daily.
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment necessary for CrCl > 10 mL/min.
* **Hepatic Impairment:** No adjustment required unless combined with severe renal impairment.
* **Hemodialysis:** No supplemental dose required post-dialysis.
## Contraindications
* Hypersensitivity to cephalosporins or beta-lactams.
* **Neonates (≤ 28 days):** Concurrent use with calcium-containing IV solutions (risk of ceftriaxone-calcium salt precipitation in lungs and kidneys).
* Hyperbilirubinemic neonates, especially premature infants.
## Adverse Effects
* **Common:** Injection site pain/induration, diarrhea, rash.
* **Serious:** Biliary sludge/pseudolithiasis ("ceftriaxone sludge"), Clostridioides difficile-associated diarrhea, hemolytic anemia, anaphylaxis.
## Key Drug Interactions
* **Calcium-containing products:** Do not administer via the same IV line; avoid co-administration in neonates.
* **Oral Contraceptives:** May reduce efficacy; backup contraception recommended during therapy.
* **Warfarin:** May enhance anticoagulant effect (monitor INR).
## Monitoring
* Baseline renal and hepatic function.
* Signs of biliary obstruction if treatment is prolonged.
* Clinical response to therapy; culture and sensitivity results.
* Monitor for signs of superinfection (e.g., C. difficile diarrhea).
## Clinical Pearls
* **IV/IM administration:** Reconstitute with lidocaine (if using 1% or 2% solution) for IM injections to reduce pain.
* **Spectrum:** Excellent activity against *Streptococcus pneumoniae*, *Haemophilus influenzae*, and *Neisseria* species; maintains activity against many Enterobacteriaceae.
* **Pseudomonas:** Note that ceftriaxone has limited to no reliable activity against *Pseudomonas aeruginosa*.
* **Local Policy:** Specific dosage regimens for severe hospital-acquired infections or serious infections like endocarditis should always adhere to your institution's local microbiology antibiogram and clinical guidelines.
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*Disclaimer: This information is for educational purposes and does not replace medical judgment. Verify current prescribing information, institutional guidelines, and weight-based dosing requirements in electronic health records before ordering.*
