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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation, broad-spectrum cephalosporin antibiotic. It exhibits long plasma half-life (approx. 8 hours), allowing for once-daily dosing. It is excreted by both hepatic (biliary) and renal pathways.
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Complicated intra-abdominal infections
* Gonococcal infections (GC)
* Pyelonephritis and complicated urinary tract infections
* Skin and soft tissue infections
* Bacterial endocarditis
## Adult Dosing
* **Standard infections:** 1 to 2 grams IV/IM once daily.
* **Meningitis:** 2 grams IV every 12 hours (maximum 4 grams/day).
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (patients <150 kg; 1g if ≥150 kg).
* **Maximum Dose:** Generally 2 grams per dose for most infections; 4 grams/day for severe infections (e.g., meningitis or CNS infections).
## Pediatric Dosing
* **General infections:** 50–75 mg/kg IV once daily (Max: 2 grams/day).
* **Meningitis:** 80–100 mg/kg IV once daily (Max: 4 grams/day).
* **Neonates (≤28 days):** 50 mg/kg/dose once daily. Avoid in neonates ≤28 days if requiring calcium-containing IV solutions.
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment necessary for CrCl ≥10 mL/min.
* **Hepatic Impairment:** No adjustment unless severe concomitant renal failure exists.
* **Dialysis:** Supplemental dose not typically required.
## Contraindications
* Hypersensitivity to ceftriaxone or other cephalosporins (cross-reactivity with penicillin may occur in those with severe IgE-mediated reactions).
* **Neonates (≤28 days):** Concurrent use of calcium-containing IV solutions (risk of ceftriaxone-calcium precipitates in lungs/kidneys).
## Adverse Effects
* **Common:** Injection site reactions (pain), diarrhea, rash, eosinophilia.
* **Serious:** Biliary sludge/pseudolithiasis (secondary to biliary precipitation), C. difficile-associated diarrhea, hemolytic anemia, anaphylaxis.
## Key Drug Interactions
* **Calcium-containing products:** Avoid concurrent IV administration via Y-site or in same line (risk of precipitation).
* **Anticoagulants:** May increase effects of Vitamin K antagonists (e.g., warfarin).
* **Aminoglycosides:** Risk of nephrotoxicity (though less than with other cephalosporins).
## Monitoring
* Monitor for signs of anaphylaxis during initial doses.
* Monitor LFTs and renal function if therapy exceeds 14 days.
* Assess for resolution of infection symptoms.
* Monitor for signs of biliary cholelithiasis (e.g., RUQ pain).
## Clinical Pearls
* Ceftriaxone is unique among cephalosporins for its long half-life, which enables once-daily administration.
* It does **not** provide coverage for *Enterococcus* or *Listeria* species.
* Intramuscular injections should be prepared with 1% lidocaine (if permitted by institutional protocol) to reduce pain.
* Always check if the indication requires anaerobic coverage (e.g., intra-abdominal infections), as ceftriaxone does not cover *Bacteroides fragilis*; metronidazole is often added.
* Dosing for specific conditions (e.g., endocarditis, osteomyelitis, Lyme disease) varies significantly; consult specific clinical guidelines (Infectious Diseases Society of America).
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**Disclaimer:** This information is for educational purposes only. Prescribing practices and local antimicrobial susceptibility patterns vary by institution. Always verify dosages, contraindications, and drug interactions using current, institutional-specific protocols and clinical drug references (e.g., Lexicomp, UpToDate) before prescribing.
