Cefriaxone%25252525252525252525252525252525252525252525252525252525252520%25252525252525252525252525252525252525252525252525252525252528ceftriaxone%25252525252525252525252525252525252525252525252525252525252529

# Ceftriaxone ## Overview Ceftriaxone is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis. It is characterized by a long half-life, allowing for once-daily dosing, and exceptional penetration into the CNS and biliary tract. ## Primary Indications * Community-acquired pneumonia * Meningitis * Complicated intra-abdominal infections (usually with metronidazole) * Gonococcal infections * Pyelonephritis / Complicated UTI * Skin and soft tissue infections ## Adult Dosing * **Standard infections:** 1–2 g IV/IM every 24 hours. * **Meningitis:** 2 g IV every 12 hours. * **Uncomplicated Gonorrhea:** 500 mg IM (single dose) for patients <150 kg; 1 g IM for patients ≥150 kg. * **Max dose:** Typically 4 g/day for severe infections. ## Pediatric Dosing * **Standard infections:** 50–75 mg/kg IV/IM once daily. * **Meningitis:** 100 mg/kg/day IV divided every 12–24 hours (max 4 g/day). * **Neonates:** 50 mg/kg/day once daily. Avoid in neonates ≤28 days old if they require calcium-containing IV solutions (due to risk of precipitation). ## Dose Adjustments * **Renal Impairment:** No dosage adjustment necessary for mild-to-moderate renal impairment. * **Hepatic Impairment:** No adjustment required; however, monitor closely if concomitant severe renal disease exists (max dose 2 g/day). * **Hemodialysis:** No supplemental dose required; administered once daily. ## Contraindications * Hypersensitivity to cephalosporins or known anaphylaxis to penicillins. * **Neonates (≤28 days):** Do not administer with calcium-containing IV solutions (e.g., Ringer's lactate) due to the risk of fatal ceftriaxone-calcium precipitates in the lungs and kidneys. ## Adverse Effects * **Common:** Injection site pain (if IM), diarrhea, rash. * **Serious:** C. difficile-associated diarrhea, hypersensitivity reactions (anaphylaxis), biliary sludge/pseudolithiasis, and hemolytic anemia (rare, with prolonged use). ## Key Drug Interactions * **Calcium-containing products:** Direct precipitation risk (avoid IV admixture). * **Oral Contraceptives:** Potential for reduced efficacy (monitor/counsel). * **Anticoagulants:** May enhance the effect of Vitamin K antagonists (monitor INR). ## Monitoring * Assess for resolution of infection signs (fever, leukocytosis). * Monitor for signs of diarrhea or *C. difficile* symptoms. * Regular LFTs and CBC are recommended for prolonged therapy (>14 days). ## Clinical Pearls * **Route:** For IM administration, inject deep into a large muscle mass (e.g., gluteus). Preparing with 1% lidocaine is common to reduce discomfort. * **Biliary:** Ceftriaxone is cleared primarily by hepatic/biliary excretion; it may cause "biliary sludge" but is generally reversible upon discontinuation. * **Dosing Protocols:** Always verify institutional protocols, as local resistance patterns and specific site-infection guidelines may necessitate dose adjustments or the addition of broader coverage (e.g., vancomycin for suspected MRSA). *** *Disclaimer: This information is for educational purposes and does not substitute for professional medical judgment. Always verify current prescribing information, institutional guidelines, and patient-specific factors before administering medication.*