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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It has a long half-life, allowing for once-daily dosing. It is excreted primarily via equal parts biliary and renal pathways.
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Gonorrhea (uncomplicated)
* Complicated intra-abdominal infections
* Pyelonephritis
* Skin and soft tissue infections
* Bacterial endocarditis
## Adult Dosing
* **Standard infections:** 1–2 g IV/IM once daily.
* **Meningitis:** 2 g IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (if weight <150 kg; 1 g if weight ≥150 kg).
* **Maximum:** 4 g daily (used in severe CNS infections).
## Pediatric Dosing
* **General infections:** 50–75 mg/kg/day IV divided once or twice daily.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (maximum 4 g/day).
* **Gonococcal ophthalmia neonatorum (prophylaxis/treatment):** 25–50 mg/kg IV/IM as a single dose (max 125 mg).
* **Note:** Always verify specific weight-based protocols for neonates/infants.
## Dose Adjustments
* **Renal Impairment:** No standard adjustment required for mild to severe renal impairment.
* **Hepatic Impairment:** Generally no adjustment required; however, use caution if severe concomitant renal and hepatic failure exist (monitor plasma concentrations if possible).
## Contraindications
* Hypersensitivity to cephalosporins.
* **Neonates (≤28 days):** Contraindicated in those requiring (or expected to require) calcium-containing IV solutions (including TPN) due to risk of ceftriaxone-calcium precipitates in the lungs and kidneys.
## Adverse Effects
* **Common:** Injection site reactions (pain), diarrhea, rash.
* **Serious:** Biliary sludge (pseudolithiasis), *Clostridioides difficile*-associated diarrhea, hemolytic anemia, anaphylaxis.
## Key Drug Interactions
* **Calcium-containing IV solutions:** Risk of life-threatening crystalline precipitation (avoid in neonates; use caution in adults by flushing lines thoroughly between administrations).
* **Oral Contraceptives:** May reduce efficacy of estrogen-containing contraceptives.
* **Warfarin:** Potential for increased INR due to alteration of gut flora (vitamin K synthesis).
## Monitoring
* Monitor for signs of anaphylaxis during initial dose.
* Persistent diarrhea (r/o *C. difficile*).
* Monitor for biliary symptoms (RUQ pain).
* CBC and LFTs if therapy duration exceeds 10–14 days.
## Clinical Pearls
* Ceftriaxone is not effective against Enterococcus species or MRSA.
* Ensure a minimum of 48 hours of time since the last ceftriaxone dose before administering calcium-containing products in neonates.
* Always consult local antibiograms; susceptibility patterns for *Pseudomonas aeruginosa* vary significantly.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify dosages, contraindications, and drug interactions against current prescribing information (e.g., package insert, Lexicomp, or institutional protocols) before administration.*
