Please check your internet connection and try again.
# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative organisms. It exhibits long plasma half-life (approx. 8 hours), allowing for once-daily dosing. It is excreted via both biliary and renal pathways.
## Primary Indications
* Community-acquired pneumonia
* Meningitis (coverage for *S. pneumoniae, N. meningitidis, H. influenzae*)
* Gonococcal infections
* Complicated intra-abdominal infections (in combination with metronidazole)
* Pyelonephritis and complicated urinary tract infections
* Skin and 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 (single dose) for patients < 150 kg; 1 g for ≥ 150 kg.
* **Maximum:** 4 g/day for severe infections.
## Pediatric Dosing
* **General infections:** 50–75 mg/kg IV/IM once daily (Max: 2 g/day).
* **Meningitis:** 100 mg/kg/day divided every 12 or 24 hours (Max: 4 g/day).
* **Neonates (postnatal age ≤ 28 days):** 50 mg/kg once daily. Avoid in neonates requiring calcium-containing IV solutions.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment required for renal failure, provided liver function is normal.
* **Hepatic Impairment:** No standard dose reduction required; however, monitor closely for toxicity if severe hepatic injury exists alongside renal impairment.
* **Dialysis:** Supplemental dose not typically required.
## Contraindications
* Hypersensitivity to cephalosporins or severe hypersensitivity to penicillins (history of anaphylaxis).
* **Neonatal use:** Concomitant use with intravenous calcium-containing products (including calcium-containing TPN) due to risk of ceftriaxone-calcium precipitates in the lungs and kidneys.
## Adverse Effects
* **Common:** Injection site pain/induration, eosinophilia, diarrhea, elevated liver enzymes.
* **Rare but serious:** *C. difficile*-associated diarrhea, biliary sludge/pseudolithiasis, hemolytic anemia, anaphylaxis.
## Key Drug Interactions
* **Calcium-containing products:** Risk of precipitation (do not administer within 48 hours of each other in neonates).
* **Oral Contraceptives:** Potential for decreased efficacy (rare, but counseling is advised).
* **Warfarin:** May enhance the effects of vitamin K antagonists due to gut flora modification.
## Monitoring
* **Clinical:** Resolution of infection signs (fever, WBC count).
* **Safety:** Monitor for signs of *C. difficile* (persistent diarrhea), especially if therapy extends beyond 7-10 days.
* **Labs:** Periodically monitor LFTs and CBC for prolonged therapy. If biliary sludge is suspected, consider abdominal ultrasound.
## Clinical Pearls
* **Administration:** IM injections should be reconstituted with 1% lidocaine to reduce pain.
* **Route:** IM administration is as effective as IV for most non-CNS infections.
* **Hospital Protocol:** Always cross-reference with local institutional antibiograms, as susceptibility (e.g., *E. coli, P. aeruginosa*) varies regionally.
* **Biliary:** Ceftriaxone is excreted primarily through bile, making it a poor choice for urinary tract infections caused by organisms with high MICs unless susceptibility is confirmed.
***
**Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and institutional protocols vary; always verify current prescribing information, patient-specific factors, and hospital antibiograms before administering medication.
