Please check your internet connection and try again.
# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative organisms. It possesses a long half-life (approx. 8 hours), allowing for once-daily dosing.
## Primary Indications
* Community-acquired pneumonia
* Meningitis and central nervous system infections
* Complicated intra-abdominal infections
* Pyelonephritis and complicated urinary tract infections
* Gonococcal infections
* Bacterial endocarditis
* Surgical prophylaxis
## Adult Dosing
* **Common Infections:** 1 to 2 grams IV/IM once daily.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (for patients <150 kg; use 1 g for ≥150 kg).
* **Maximum Dose:** 4 grams per day (rarely, 2g twice daily).
## Pediatric Dosing
* **General Infections:** 50–75 mg/kg/day IV/IM administered once daily.
* **Meningitis:** 80–100 mg/kg/day IV divided every 12 hours (max 4 g/day).
* **Neonates (Postnatal age 0-28 days):** 50 mg/kg once daily.
* **Note:** Dosing varies significantly by indication and institutional protocol. Always verify per weight-based formulas.
## Dose Adjustments
* **Renal Impairment:** No adjustment required for mild to moderate renal insufficiency.
* **Hepatic Impairment:** No adjustment required; however, monitor closely if severe renal impairment coexists.
* **Dialysis:** Supplemental dosing is generally not required.
## Contraindications
* Hypersensitivity to ceftriaxone, penicillins, or other cephalosporins (cross-reactivity risk is small but clinically relevant).
* **Neonates (≤28 days):** Concomitant use with calcium-containing intravenous solutions due to the risk of ceftriaxone-calcium precipitates in the lungs and kidneys.
## Adverse Effects
* **Common:** Injection site pain/induration, diarrhea, rash.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludge or "pseudolithiasis" (reversible gallbladder precipitates), hemolysis, neutropenia, and anaphylaxis.
## Key Drug Interactions
* **Calcium-containing products (IV):** Interaction with Ringer’s lactate or other calcium-containing fluids in the same IV line can cause fatal precipitate formation in neonates.
* **Warfarin:** May enhance the anticoagulant effect by altering gut flora (vitamin K deficiency/interference); monitor INR.
## Monitoring
* Monitor CBC in prolonged therapy (risk of neutropenia/thrombocytopenia).
* Monitor LFTs if therapy duration exceeds 10–14 days.
* Assess for signs of biliary sludge or gallbladder disease (RUQ pain).
* Observe for signs of *C. difficile* infection (uncontrolled diarrhea).
## Clinical Pearls
* Ceftriaxone is highly protein-bound; it displaces bilirubin from albumin. It is strictly contraindicated in hyperbilirubinemia neonates.
* Not active against *Enterococcus* spp., *Listeria monocytogenes*, or MRSA.
* Available as IV or IM. When administered IM, it is often reconstituted with 1% lidocaine to reduce injection site pain.
* Always ensure intravenous lines are flushed thoroughly between ceftriaxone and calcium-containing solutions to avoid precipitation.
***
**Educational Disclaimer:** This information is for educational purposes only. Clinical dosing and protocols vary by institution and patient-specific factors (e.g., age, weight, organ function). Always verify current prescribing information in established clinical resources (e.g., Lexicomp, UpToDate) or local antimicrobial stewardship guidelines before prescribing.
