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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 possesses a long serum half-life (approximately 8 hours), allowing for once-daily dosing.
## Primary Indications
Common indications include community-acquired pneumonia, complicated intra-abdominal infections, meningitis, pyelonephritis, skin and soft tissue infections, and gonorrhea.
## Adult Dosing
* **Standard infections:** 1–2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Gonorrhea (uncomplicated):** 500 mg IM as a single dose (for patients <150 kg; use 1 g for ≥150 kg).
* **Maximum dose:** Typically 4 g/day for severe infections.
## Pediatric Dosing
* **General infections:** 50–75 mg/kg/day IV/IM administered once daily (Maximum: 2 g/day).
* **Meningitis:** 100 mg/kg/day IV divided every 12–24 hours (Initial dose: 100 mg/kg; Maximum: 4 g/day).
* *Note: Dosing depends on institutional protocols; verify neonate-specific dosing due to hyperbilirubinemia risks.*
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is required in patients with renal impairment.
* **Hepatic Impairment:** No dose adjustment required if renal function is normal.
* **Combined Hepatic/Renal Impairment:** Monitor serum concentrations closely; maximum daily dose may require reduction.
## Contraindications
* Hypersensitivity to cephalosporins.
* **Neonates (≤28 days):** Contraindicated if the infant requires (or is expected to require) concomitant calcium-containing IV solutions/products due to risk of precipitation (ceftriaxone-calcium salt) in the lungs and kidneys.
## Adverse Effects
* **Common:** Injection site pain, diarrhea, eosinophilia.
* **Serious:** Biliary sludge/pseudolithiasis (ceftriaxone-calcium precipitates in bile), Clostridioides difficile-associated diarrhea, anaphylaxis, and hemolytic anemia.
## Key Drug Interactions
* **Calcium-containing products:** Do not administer or flush IV lines with calcium-containing solutions (e.g., Lactated Ringer’s, TPN) in the same line or simultaneously.
* **Oral Contraceptives:** May decrease efficacy (clinical significance is debated).
* **Vitamin K Antagonists (e.g., Warfarin):** May increase INR; monitor closely when initiating antibiotic therapy.
## Monitoring
* Monitor for signs of anaphylaxis, especially with the first dose.
* Assess for resolution of infection symptoms.
* Watch for signs of biliary sludge or gallbladder "pseudolithiasis" in patients presenting with right upper quadrant abdominal pain.
* Monitor stool frequency if diarrhea develops.
## Clinical Pearls
* Ceftriaxone is not active against *Enterococcus* species, methicillin-resistant *Staphylococcus aureus* (MRSA), or *Pseudomonas aeruginosa* (in most standard dosing/indications).
* The intramuscular formulation should be reconstituted with lidocaine 1% to reduce injection site discomfort, provided the patient has no hypersensitivity to lidocaine.
* Ceftriaxone has excellent CNS penetration, making it a first-line choice for bacterial meningitis.
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**Disclaimer:** This information is for educational purposes only. Clinical practice guidelines vary by institution and local resistance patterns. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.
