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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 a high degree of stability against beta-lactamases.
## Primary Indications
Common indications include community-acquired pneumonia, bacterial meningitis, pyelonephritis, complicated intra-abdominal infections, gonorrhea, pelvic inflammatory disease, and skin/soft tissue infections.
## Adult Dosing
* **Standard infections:** 1–2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose (increase to 1 g for patients ≥150 kg).
* **Maximum dose:** Typically 4 g/day for severe infections.
## Pediatric Dosing
* **General infections:** 50–75 mg/kg/day IV/IM administered in 1–2 divided doses.
* **Meningitis:** 100 mg/kg/day (maximum 4 g/day) administered once daily or in two divided doses.
* **Neonates (≤28 days):** 50 mg/kg once daily. Avoid in hyperbilirubinemia or if receiving calcium-containing IV solutions.
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment is required in patients with renal impairment, provided hepatic function is normal.
* **Hepatic Impairment:** No adjustment recommended, but monitor serum concentrations in cases of severe combined hepatic and renal dysfunction.
## Contraindications
* Hypersensitivity to cephalosporins or anaphylaxis to penicillins.
* **Neonates (≤28 days):** Concurrent use with calcium-containing IV solutions (risk of precipitation in lungs and kidneys).
## Adverse Effects
* **Common:** Injection site reactions (pain/induration), diarrhea (potential *C. difficile* risk), rash.
* **Serious:** Biliary sludging (biliary pseudolithiasis), hemolytic anemia, anaphylaxis, and *Clostridioides difficile*-associated diarrhea.
## Key Drug Interactions
* **Calcium-containing products:** Do not mix or co-administer with IV calcium-containing solutions (e.g., Ringer's lactate) in the same line due to physical incompatibility; avoid for 48 hours in neonates.
* **Oral contraceptives:** May decrease efficacy; advise secondary contraception.
* **Vitamin K antagonists:** May enhance the anticoagulant effect of warfarin (monitor INR).
## Monitoring
* Monitor for signs of hypersensitivity reactions.
* If treatment is prolonged (>14 days), monitor for biliary sludge/gallbladder ultrasound if clinically indicated.
* Monitor CBC and renal function during long-term therapy.
## Clinical Pearls
* **Administration:** IM injections should be administered in a large muscle mass (e.g., gluteus). Preparing IM doses with 1% lidocaine is common to reduce injection pain.
* **CSF Penetration:** Excellent penetration into the cerebrospinal fluid, making it a first-line agent for bacterial meningitis.
* **Spectrum Gap:** Like many cephalosporins, it lacks activity against *Enterococcus* species, *Listeria monocytogenes*, and methicillin-resistant *Staphylococcus aureus* (MRSA).
* **Dosing Protocols:** Always defer to institutional antibiograms and internal treatment protocols for local resistance patterns and dosing variants.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Clinical prescribing should always be guided by the most current institutional protocols, updated package inserts, and evidence-based clinical judgment. Always verify current prescribing information before administration.
