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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic. It exhibits broad-spectrum activity against many Gram-negative and Gram-positive organisms and has a long half-life, allowing for once-daily dosing. It is highly protein-bound and primarily excreted via hepatic and renal pathways.
## Primary Indications
Common indications include community-acquired pneumonia, meningitis, complicated intra-abdominal infections, pyelonephritis, uncomplicated gonorrhea, and sepsis. Often used empirically for suspected bacterial infections in emergency or inpatient settings.
## 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 (for patients <150 kg; 1 g for >150 kg).
* **Maximum Dose:** 4 g/day (typically for severe infections/meningitis).
## Pediatric Dosing
* **General Infection:** 50–75 mg/kg/day IV/IM divided once or twice daily (Max: 2 g/day).
* **Meningitis:** 100 mg/kg/day IV divided every 12–24 hours (Max: 4 g/day).
* **Neonates (>7 days):** 50 mg/kg/day once daily.
* **Note:** Contraindicated in hyperbilirubinemic neonates and neonates requiring calcium-containing solutions.
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment indicated for renal failure provided hepatic function is normal.
* **Hepatic Impairment:** No specific adjustment needed; however, monitor closely if concurrent severe renal impairment is present.
* **Dialysis:** Supplemental dose not typically required.
## Contraindications
* Hypersensitivity to cephalosporins or history of anaphylaxis to penicillins (caution).
* **Neonates (≤28 days):** Do not administer with calcium-containing IV products due to risk of ceftriaxone-calcium salt precipitation (fatal in lungs/kidneys).
* **Preterm infants:** Contraindicated if hyperbilirubinemic (ceftriaxone can displace bilirubin from albumin).
## Adverse Effects
* **Common:** Injection site reactions (pain), diarrhea, rash, eosinophilia.
* **Serious:** Biliary sludge/pseudolithiasis (often reversible), Clostridioides difficile infection, hemolytic anemia, and anaphylaxis.
## Key Drug Interactions
* **Calcium-containing products:** Do not co-administer (e.g., in TPN or LR) in neonates. In adults, separate by at least 48 hours or check lines carefully for compatibility.
* **Oral Contraceptives:** Potential for decreased efficacy (rare, but counseling is advised).
* **Warfarin:** May enhance anticoagulant effect (vitamin K depletion by gut flora alteration).
## Monitoring
* Monitor for signs of biliary sludge or symptomatic cholelithiasis (RUQ pain).
* Perform periodic CBC in prolonged therapy to monitor for neutropenia or hemolytic anemia.
* Assess site of administration for irritation/thrombophlebitis.
## Clinical Pearls
* **Spectrum:** Not active against *Enterococcus* species, methicillin-resistant *Staphylococcus aureus* (MRSA), or *Pseudomonas aeruginosa* (in most clinical applications).
* **Route:** IM administration can be painful; lidocaine (1% without epinephrine) is often used as a diluent for IM injections to improve tolerability.
* **Dosing protocol:** Always adhere to institutional antimicrobial stewardship guidelines regarding empiric choices and duration of therapy.
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*Disclaimer: This information is for educational purposes only and does not constitute medical advice. Dosing, contraindications, and drug compatibility must be verified against current institutional protocols, the package insert, and clinical decision support resources (such as Lexicomp or Micromedex) before prescribing or administering any medication.*
