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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation, broad-spectrum cephalosporin antibiotic. It possesses a long half-life, allowing for once-daily dosing, and is characterized by dual excretion (hepatic and renal).
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Complicated intra-abdominal infections
* Gonococcal infections
* Pyelonephritis and complicated urinary tract infections
* Skin and soft tissue infections
* Empiric treatment of febrile neutropenia (in combination regimens)
## Adult Dosing
* **Standard infections:** 1–2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Gonorrhea (uncomplicated):** 500 mg IM as a single dose (for patients <150 kg; use 1 g for ≥150 kg).
* **Maximum daily dose:** Usually 4 g (higher doses may be used in specific meningitis protocols).
## Pediatric Dosing
* **General infections:** 50–75 mg/kg/day IV/IM divided every 24 hours.
* **Meningitis:** 80–100 mg/kg/day IV divided every 12–24 hours (max 4 g/day).
* **Gonococcal ophthalmia neonatorum/disseminated infection:** 25–50 mg/kg (max 125 mg) as a single dose or daily for 7 days.
* *Note: Neonates require specialized dosing and caution due to risk of biliary sludge.*
## Dose Adjustments
* **Renal Impairment:** No standard adjustment required for mild to severe renal impairment.
* **Hepatic Impairment:** No standard adjustment required for mild to moderate hepatic impairment.
* **Severe Renal and Hepatic Insufficiency:** Monitor closely; use caution if both are impaired simultaneously.
## Contraindications
* **Hypersensitivity:** Known hypersensitivity to ceftriaxone or any cephalosporin.
* **Neonates (≤28 days):** Concurrent use with calcium-containing IV solutions (including Ringer's lactate or parenteral nutrition) due to the risk of ceftriaxone-calcium salt precipitation in the lungs and kidneys.
## Adverse Effects
* **Biliary sludge/pseudolithiasis:** Associated with high doses or prolonged use; gallbladder ultrasound may be needed.
* **Gastrointestinal:** Diarrhea, *Clostridioides difficile*-associated diarrhea.
* **Hematologic:** Eosinophilia, leukopenia, thrombocytosis.
* **Injection site reactions:** Pain induration at IV/IM site.
## Key Drug Interactions
* **Calcium-containing products:** Absolute contraindication in neonates; in patients >28 days, flush lines thoroughly or avoid concurrent administration.
* **Warfarin:** May enhance anticoagulant effect; monitor INR.
## Monitoring
* Monitor for signs of *C. difficile* (persistent diarrhea).
* Monitor for signs of hepatobiliary distress (right upper quadrant pain, jaundice) during long-term therapy.
* Laboratory monitoring is typically unnecessary for short courses, but check CBC and LFTs if therapy exceeds 10–14 days.
## Clinical Pearls
* **Dual clearance:** Because ~40% is excreted in the bile and ~60% in the urine, no dose reduction is required for renal failure, making it a preferred antibiotic in patients with fluctuating creatinine clearance.
* **IV/IM usage:** Can be administered IM; reconstitution with 1% lidocaine is often used to reduce injection site pain.
* **Spectrums:** Poor activity against *Enterococcus* species and methicillin-resistant *Staphylococcus aureus* (MRSA).
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**Disclaimer:** This information is for educational purposes only. Dosing may vary based on local institutional protocols, site of infection, and patient-specific factors. Always verify prescribing information and institutional guidelines via your hospital’s pharmacy department or official clinical resources (e.g., Lexicomp, UpToDate) before prescribing.
