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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative bacteria. It has a long half-life (approx. 8 hours), allowing for once-daily dosing. It is excreted via both biliary and renal pathways.
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Gonococcal infections
* Acute otitis media (single dose)
* Surgical prophylaxis
* Complicated intra-abdominal, skin/soft tissue, and urinary tract infections
## Adult Dosing
* **Standard infections:** 1–2 g IV/IM daily.
* **Meningitis:** 2 g IV every 12 hours.
* **Gonorrhea:** 500 mg IM (single dose) for patients <150 kg; 1 g IM for patients ≥150 kg.
* **Maximum:** 4 g/day in severe infections.
## Pediatric Dosing
* **Standard infections:** 50–75 mg/kg IV/IM once daily.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (max 4 g/day).
* **Acute otitis media:** 50 mg/kg IM (single dose).
* **Neonates (≤ 28 days):** 50 mg/kg once daily. Avoid in hyperbilirubinemia or if receiving calcium-containing products.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment necessary for mild-to-moderate dysfunction.
* **Hepatic Impairment:** Usually no adjustment required; however, close monitoring is advised in severe combined renal and hepatic failure.
* **Dosing note:** Local hospital antibiograms and institutional protocols should always be consulted for specific site-of-infection guidelines.
## Contraindications
* Hypersensitivity to cephalosporins.
* **Neonates (≤ 28 days):** Concurrent use with calcium-containing IV solutions (risk of fatal crystalline precipitation in lungs/kidneys).
* Patients with hyperbilirubinemia (especially premature infants).
## Adverse Effects
* **Common:** Injection site reactions (pain/induration), diarrhea, rash.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludge/pseudolithiasis (long-term use), hemolytic anemia, anaphylaxis.
## Key Drug Interactions
* **Calcium-containing products:** Absolute contraindication in neonates; monitor in older patients (separate administration by ≥48 hours if possible).
* **Anticoagulants:** May enhance the effects of Vitamin K antagonists (e.g., warfarin); monitor INR.
## Monitoring
* Monitor for signs of hypersensitivity (anaphylaxis).
* Monitor bowel habits (risk of *C. difficile*).
* In prolonged therapy (>14 days), consider gallbladder ultrasound if symptoms of biliary colic occur.
* Monitor CBC/LFTs in prolonged therapy.
## Clinical Pearls
* Ceftriaxone does not require renal dose adjustments, making it a preferred choice in patients with unstable renal function.
* It is not active against *Enterococcus* species or methicillin-resistant *Staphylococcus aureus* (MRSA).
* IM injections can be painful; consider reconstitution with 1% lidocaine (nonaqueous) to minimize discomfort, provided the patient is not allergic to lidocaine.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Dosing protocols vary by institution and patient status. Always verify the current prescribing information and local infectious disease guidelines before administering medication.*
