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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation, long-acting cephalosporin antibiotic. It possesses broad-spectrum activity against many Gram-positive and Gram-negative organisms, including *Streptococcus pneumoniae*, *Haemophilus influenzae*, and *Neisseria* species. It has excellent CNS penetration.
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Complicated intra-abdominal infections
* Gonococcal infections
* Pyelonephritis and complicated UTIs
* Skin and skin structure infections
* Empiric sepsis treatment
## Adult Dosing
* **Standard infections:** 1–2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Gonorrhea:** 500 mg IM as a single dose (patients <150 kg; use 1 g if ≥150 kg).
* **Maximum dose:** Typically 4 g per day for severe infections.
## Pediatric Dosing
* **General bacterial infections:** 50–75 mg/kg/day IV/IM divided every 12–24 hours (Max 2 g/day).
* **Meningitis:** Initial 100 mg/kg/day (Max 4 g/day) as a single daily dose or divided every 12 hours.
* **Neonates (Postnatal age ≤28 days):** 50 mg/kg/day once daily. Avoid in neonates requiring calcium-containing IV solutions.
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment necessary.
* **Hepatic Impairment:** No dosage adjustment necessary if renal function is preserved; however, monitor levels if severe hepatic and renal dysfunction coexist.
## Contraindications
* Known hypersensitivity to ceftriaxone or other cephalosporins (careful assessment of penicillin allergy cross-reactivity required).
* Hyperbilirubinemic neonates, especially premature infants.
* **Neonates (≤28 days):** Concurrent use of calcium-containing IV products (including TPN) due to risk of precipitation (ceftriaxone-calcium salt) in lungs and kidneys.
## Adverse Effects
* **Common:** Injection site reactions (pain/induration), diarrhea (including *C. difficile* risk), rash.
* **Serious:** Biliary sludging/pseudolithiasis, hemolytic anemia, prolonged prothrombin time (hypoprothrombinemia), anaphylaxis.
## Key Drug Interactions
* **Calcium-containing products:** Absolute contraindication in neonates; monitor closely in older patients (separate administration by at least 48 hours is often advised if both are required).
* **Oral Contraceptives:** Potential for reduced efficacy (rare, but clinical caution advised).
## Monitoring
* Baseline and periodic assessment of renal and hepatic function.
* Monitor for signs of *C. difficile*-associated diarrhea.
* In prolonged therapy (>14 days), consider gallbladder ultrasound if symptoms of biliary colic develop.
* Monitor for signs of bleeding (if on anticoagulants or with long-term therapy).
## Clinical Pearls
* Ceftriaxone is not active against MRSA, *Enterococcus* species, or *Pseudomonas aeruginosa*.
* Lidocaine (1%) is often used as a diluent for IM injections to reduce pain.
* **Biliary Sludging:** Ceftriaxone is excreted primarily via the biliary tract; biliary "pseudolithiasis" is a reversible condition caused by the precipitation of ceftriaxone-calcium salt in the gallbladder.
* Always verify dosing and institutional protocols for specific infection types, as local resistance patterns vary significantly.
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*Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors with clinical guidelines and drug references before prescribing or administering medication.*
