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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation, broad-spectrum cephalosporin antibiotic. It exhibits long half-life (approx. 8 hours), allowing for once-daily dosing. Highly protein-bound; exhibits excellent tissue penetration, including the CSF.
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Complicated intra-abdominal infections
* Gonococcal infections
* Pyelonephritis and complicated UTIs
* Skin and skin structure infections
* Surgical prophylaxis
## Adult Dosing
* **Standard infections:** 1–2 g IV/IM every 24 hours.
* **Meningitis:** 2 g IV every 12 hours (often initiated with dexamethasone).
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (if <150kg); 1g if ≥150kg.
* **Max dose:** 4 g/day in 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 12–24 hours (max 4 g/day).
* **Neonates (postnatal age > 7 days):** 50 mg/kg once daily.
* *Note:* Avoid in hyperbilirubinemic neonates (see Contraindications).
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment necessary.
* **Hepatic Impairment:** No dosage adjustment necessary.
* **Combined Renal/Hepatic Failure:** Monitor serum concentrations if therapy is prolonged; max dose may require reduction.
## Contraindications
* Hypersensitivity to cephalosporins or known anaphylaxis to penicillins.
* **Neonates (≤28 days):** Concurrent use with calcium-containing IV solutions (risk of precipitation in lungs/kidneys) or hyperbilirubinemia (ceftriaxone displaces bilirubin from albumin).
## Adverse Effects
* **Common:** Injection site reactions (pain/induration), diarrhea, eosinophilia.
* **Serious:** *C. diff*-associated diarrhea, biliary sludge/pseudolithiasis (cholecystitis-like syndrome), hemolytic anemia, and anaphylaxis.
## Key Drug Interactions
* **Calcium-containing products:** Do not administer IV lines simultaneously with IV calcium (e.g., Ringer's lactate) or within 48 hours in neonates due to precipitation risk.
* **Oral anticoagulants:** May enhance the effects of Vitamin K antagonists (e.g., warfarin).
* **Live Vaccines:** May decrease the efficacy of BCG, cholera, and typhoid vaccines.
## Monitoring
* Signs of hypersensitivity/anaphylaxis during initial dose.
* Monitor for signs of cholelithiasis in patients with high-dose/long-term therapy (RUQ pain, jaundice).
* Resolution of infection symptoms and WBC indices.
## Clinical Pearls
* **Biliary Issues:** Ceftriaxone is excreted primarily via the biliary system; biliary pseudolithiasis is reversible upon drug discontinuation.
* **IM Administration:** If IM dose exceeds 1 g, split into two sites or use 1% lidocaine for reconstitution to reduce pain.
* **Spectrum:** Lacks activity against *Enterococcus* species, *Listeria monocytogenes*, and MRSA.
* **Local Protocols:** Always verify dosing against institutional antibiograms and infectious disease guidelines, as site-specific susceptibility and regional resistance patterns significantly influence empiric choice.
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*Disclaimer: This information is for educational purposes only. Clinical practice guidelines and local resistance patterns vary. Always verify dosages and contraindications through institutional protocols, official package inserts, or clinical decision support tools (e.g., UpToDate, Lexicomp) before prescribing.*
