Please check your internet connection and try again.
# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). It possesses broad-spectrum activity against most Gram-positive and Gram-negative organisms, with notable activity against *Streptococcus pneumoniae*, *Neisseria* species, and *Haemophilus influenzae*.
## Primary Indications
* Community-acquired pneumonia
* Meningitis (empiric therapy)
* Gonococcal infections
* Intra-abdominal infections (in combination with metronidazole)
* Pyelonephritis and complicated urinary tract infections
* Skin and soft tissue infections
* Surgical prophylaxis
## Adult Dosing
* **Standard infections:** 1 to 2 grams IV/IM every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Gonorrhea:** 500 mg IM as a single dose (if patient weight <150 kg; 1 g if ≥150 kg).
* **Max dose:** 4 grams per day (rarely used, typically restricted to CNS infections or specific multidrug-resistant protocols).
## Pediatric Dosing
* **Standard infections:** 50 to 80 mg/kg/day IV/IM once daily.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (max 4 grams/day).
* **Neonates:** Not recommended in neonates ≤28 days, particularly those requiring calcium-containing products (risk of precipitation).
## Dose Adjustments
* **Renal Impairment:** No dose adjustment required.
* **Hepatic Impairment:** No dose adjustment required.
* **Combined Renal/Hepatic Failure:** Monitor serum drug levels if available; clinical caution is advised.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins (if severe reaction present).
* **Neonates (≤28 days):** Risk of fatal precipitates in lungs and kidneys if administered with calcium-containing IV solutions (e.g., Ringer’s lactate, parenteral nutrition).
## Adverse Effects
* **Gastrointestinal:** Diarrhea, *Clostridioides difficile*-associated diarrhea.
* **Hematologic:** Eosinophilia, thrombocytosis, leukopenia.
* **Dermatologic:** Rash, pruritus.
* **Hepatic/Biliary:** Biliary sludge or pseudolithiasis (more common in pediatrics).
* **Injection site:** Pain or induration (if given IM).
## Key Drug Interactions
* **Calcium-containing products:** Absolute contraindication in neonates; avoid Y-site compatibility for all ages to prevent calcium-ceftriaxone precipitate formation.
* **Warfarin:** May enhance anticoagulant effect (monitor INR).
* **Aminoglycosides:** Potential for synergistic antimicrobial activity, but do not mix in the same IV container.
## Monitoring
* Monitor for signs of hypersensitivity.
* Assess for improvement in infection symptoms (fever, leukocytosis, culture results).
* Monitor LFTs and renal function if therapy exceeds 14 days.
* Diarrhea lasting >48 hours should be evaluated for *C. difficile*.
## Clinical Pearls
* **Stability:** Once reconstituted with D5W or NS, the solution is generally stable for 24 hours at room temperature.
* **Spectrum:** It has limited activity against *Enterococcus* species, *Pseudomonas aeruginosa*, and MRSA.
* **Route:** IM injection is often painful; reconstitution with 1% lidocaine is sometimes used (per local policy) to minimize discomfort, provided no contraindications to lidocaine exist.
***
*Disclaimer: This information is for educational purposes only. Dosing protocols can vary significantly based on institutional guidelines, severity of illness, and source of infection. Always consult your facility’s antimicrobial stewardship program, local antibiogram, and the most current FDA-approved prescribing information before administering medication.*
