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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative organisms. It possesses a long elimination half-life, allowing for once-daily or twice-daily dosing.
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Skin and soft tissue infections
* Complicated intra-abdominal infections
* Gonococcal infections
* Pyelonephritis
* Surgical prophylaxis
## Adult Dosing
* **Standard infections:** 1 g to 2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM (single dose, patients <150kg; 1g if ≥150kg).
* **Max dose:** 4 g/day in severe infections (e.g., meningitis).
## Pediatric Dosing
* **General infections:** 50–75 mg/kg/day IV divided every 12–24 hours (Max 2 g/day).
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (Max 4 g/day), often preceded by a 100 mg/kg loading dose.
* **Neonates (postnatal age ≥7 days):** 50 mg/kg/day IV once daily.
## Dose Adjustments
* **Renal Impairment:** No standard dosage adjustment required for CrCl ≥10 mL/min.
* **Hepatic Impairment:** No adjustment required; however, monitor if combined with severe renal impairment.
* **Biliary Issues:** Use caution; ceftriaxone can precipitate in the gallbladder.
## Contraindications
* Hypersensitivity to cephalosporins or any component of the formulation.
* **Neonates (≤28 days):** Use prohibited if requiring calcium-containing IV solutions (risk of fatal crystalline precipitations in lungs/kidneys).
* **Hyperbilirubinemic neonates:** Ceftriaxone may displace bilirubin from albumin binding sites, increasing the risk of kernicterus.
## Adverse Effects
* **Common:** Injection site reactions (pain/induration), diarrhea, rash.
* **Serious:** Biliary sludge/cholelithiasis (biliary pseudolithiasis), *Clostridioides difficile* infection, hemolytic anemia, anaphylaxis.
## Key Drug Interactions
* **Calcium-containing products:** Do not administer via IV Y-site or same line as calcium (e.g., Ringer's solution, TPN) in neonates. In adults, flush lines thoroughly between administrations.
* **Vitamin K Antagonists:** May enhance the anticoagulant effect of warfarin; monitor INR.
## Monitoring
* Monitor for signs of hypersensitivity.
* Monitor for *C. difficile*-associated diarrhea.
* In prolonged therapy, perform periodic LFTs and CBC (monitor for leukopenia/neutropenia).
## Clinical Pearls
* Ceftriaxone is purely biliary/renal dual excretion; therefore, it does not require dosage titration for most renal failure patients.
* Do not reconstitute with diluents containing calcium (e.g., Ringer's lactate).
* Always ensure the patient is not allergic to penicillin (cross-reactivity risk is low but exists).
* *Specific protocols:* Dosing may vary significantly by institution depending on local antibiograms; always consult your hospital's internal antimicrobial stewardship guidelines.
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**Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and specific patient weight-based requirements before administering medication. Contact a clinical pharmacist for complex clinical decisions.
