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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative organisms. It exhibits a long half-life, allowing for once-daily dosing.
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Complicated intra-abdominal infections
* Gonorrhea (uncomplicated)
* Pyelonephritis and urinary tract infections
* Skin and soft tissue infections
* Empiric treatment of bacteremia/sepsis
## Adult Dosing
* **General infections:** 1–2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours (maximum 4 g/day).
* **Gonorrhea:** 500 mg IM as a single dose (for patients <150 kg; 1 g if ≥150 kg).
* **Surgical prophylaxis:** 1–2 g IV as a single dose 30–60 minutes prior to procedure.
## Pediatric Dosing
* **General infections:** 50–75 mg/kg IV/IM once daily (maximum 2 g/day).
* **Meningitis:** Initial dose 100 mg/kg/day (maximum 4 g/day), divided every 12 or 24 hours.
* **Neonates (postnatal age ≤28 days):** 50 mg/kg/day once daily.
* **Note:** Use with caution in neonates; contraindicated in hyperbilirubinemic neonates and those receiving calcium-containing products.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No dosage adjustment is typically required in patients with combined renal and hepatic impairment; however, monitor serum concentrations if severe.
* **Hemodialysis:** No supplemental dose required; not significantly removed by hemodialysis.
## Contraindications
* Hypersensitivity to ceftriaxone, penicillins, or other cephalosporins (cross-reactivity risk).
* Hyperbilirubinemic neonates (especially premature infants).
* Concomitant use of calcium-containing IV solutions in neonates (≤28 days) due to risk of ceftriaxone-calcium precipitate.
## Adverse Effects
* **Most common:** Injection site reactions (pain/induration), diarrhea, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** C. difficile-associated diarrhea, biliary sludge/gallbladder pseudolithiasis (biliary "sludge"), hemolysis.
## Key Drug Interactions
* **Calcium-containing products:** Do not administer through the same IV line (precipitation risk).
* **Oral contraceptives:** May decrease efficacy (back-up contraception advised).
* **Vitamin K antagonists:** May enhance anticoagulant effect (monitor INR).
## Monitoring
* Signs of hypersensitivity (rash, anaphylaxis).
* Signs of C. difficile colitis (persistent diarrhea).
* Hepatic/renal function and CBC during prolonged (>14 days) therapy.
* Monitor bilirubin levels in neonates.
## Clinical Pearls
* **Biliary Sludge:** Long-term use is associated with biliary pseudolithiasis. Consider abdominal ultrasound if patients develop RUQ abdominal pain.
* **Spectrum:** Excellent activity against *Streptococcus pneumoniae*, *Haemophilus influenzae*, and *Neisseria* species; lacks activity against *Enterococcus* species and methicillin-resistant *Staphylococcus aureus* (MRSA).
* **Administration:** IM injections should be administered in a large muscle mass; doses >1g may require split-site administration.
* **Local Policy:** Specific doses (particularly for meningitis or highly specific site infections) should always be verified against institutional antibiograms or local clinical protocols.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult current institutional guidelines, primary literature, and the official FDA package insert before prescribing or administering any medication. Clinical judgment should be individualized based on the patient's specific presentation.
