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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis. It is characterized by a long half-life (approx. 8 hours), allowing for once-daily dosing. It is primarily eliminated by both hepatic and renal routes.
## Primary Indications
- Community-acquired pneumonia
- Meningitis
- Gonorrhea (uncomplicated urogenital, rectal, and pharyngeal)
- Complicated intra-abdominal infections
- Skin and soft tissue infections
- Pyelonephritis/complicated UTI
- Prophylaxis for surgical procedures
## Adult Dosing
- **General infections:** 1–2g IV/IM once daily.
- **Meningitis:** 2g IV every 12 hours.
- **Gonorrhea (uncomplicated):** 500mg IM as a single dose (for patients <150kg; use 1g if ≥150kg).
- **Max dose:** Generally 4g/day (higher doses used in specific CNS infections).
## Pediatric Dosing
- **General infections:** 50–75mg/kg/day IV/IM once daily (Max: 2g/day).
- **Meningitis:** 100mg/kg/day divided every 12 hours (Max: 4g/day).
- **Neonates (≤28 days):** 50mg/kg/day once daily. Avoid in hyperbilirubinemic neonates and premature infants.
## Dose Adjustments
- **Renal Impairment:** No adjustment required for CrCl ≥10 mL/min.
- **Hepatic Impairment:** No adjustment required, but monitor closely if severe renal impairment coexists.
- **End-Stage Renal Disease:** No supplemental dose required post-hemodialysis.
## Contraindications
- Hypersensitivity to ceftriaxone or any cephalosporin.
- **Neonates (≤28 days):** Do not administer with calcium-containing IV solutions (risk of ceftriaxone-calcium precipitates in lungs/kidneys).
- Avoid Ringer's lactate or other calcium-containing diluents in all age groups.
## Adverse Effects
- **Common:** Injection site reactions (pain/induration), diarrhea (C. diff risk), rash.
- **Serious:** Biliary sludge/pseudolithiasis (secondary to biliary precipitation), hemolytic anemia, anaphylaxis, and Clostridioides difficile infection.
## Key Drug Interactions
- **Calcium-containing solutions:** Fatal micro-precipitation (avoid combined use via Y-site or concurrent IV administration).
- **Oral Contraceptives:** May decrease efficacy (counsel backup contraception).
- **Vitamin K Antagonists:** May enhance the anticoagulant effect of warfarin (monitor INR).
## Monitoring
- Renal and hepatic function (periodic).
- Signs of biliary symptoms (RUQ pain, jaundice).
- Monitor for signs of *C. difficile* (persistent diarrhea).
- Monitor for signs of hypersensitivity.
## Clinical Pearls
- Ceftriaxone has no activity against MRSA or *Enterococcus* species.
- If gonorrhea treatment is indicated and chlamydia has not been ruled out, co-administer appropriate therapy (e.g., doxycycline) per current CDC guidelines.
- IM administration sites should be deep (e.g., gluteus maximus) and lidocaine 1% can be added as a diluent to reduce injection pain.
- Always verify IV compatibility; it is physically incompatible with many drugs (e.g., vancomycin, fluconazole).
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice protocols vary by institution. Always verify specific dosing, safety, and compatibility guidelines via institutional pharmacy resources or current product labeling (e.g., Lexicomp, UpToDate) before prescribing or administering medication.
