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# 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 excellent tissue penetration, including the central nervous system.
## Primary Indications
* Community-acquired pneumonia
* Meningitis
* Gonococcal infections (GC)
* Complicated intra-abdominal infections
* Pyelonephritis / Complicated UTI
* Skin and soft tissue infections
* Bacterial endocarditis (as part of combination therapy)
## Adult Dosing
* **Standard infections:** 1–2 grams IV/IM once daily.
* **Meningitis:** 2 grams IV every 12 hours (maximum 4g/day).
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (if weight <150kg); 1 gram IM (if weight ≥150kg). Note: Always screen/treat for Chlamydia coinfection.
* **Bacterial Endocarditis:** 2 grams IV once daily.
## Pediatric Dosing
* **Standard infections:** 50–75 mg/kg body weight once daily (max 2g/day).
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours (max 4g/day).
* **Neonates (below 28 days):** 50 mg/kg once daily. Avoid in hyperbilirubinemia neonates.
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment necessary in mild to moderate renal failure.
* **Hepatic Impairment:** No dosage adjustment required, but monitor closely in severe concurrent renal and hepatic insufficiency.
## Contraindications
* Hypersensitivity to cephalosporins or severe anaphylactic reaction to penicillins.
* **Neonates (≤28 days):** Specifically contraindicated if requiring calcium-containing IV solutions (due to risk of ceftriaxone-calcium precipitates in lungs/kidneys).
* **Hyperbilirubinemic neonates:** Ceftriaxone displaces bilirubin from albumin-binding sites, risking kernicterus.
## Adverse Effects
* **Common:** Diarrhea, eosinophilia, injection site reaction (pain).
* **Serious:** Biliary sludging/pseudocholelithiasis (long-term therapy), C. difficile-associated diarrhea, anaphylaxis, hemolysis.
## Key Drug Interactions
* **Calcium-containing products (IV):** Must not be administered simultaneously or within 48 hours of each other (risk of fatal precipitate formation).
* **Oral Contraceptives:** Potential for reduced efficacy (though evidence is limited for parenteral cephalosporins).
* **Vitamin K Antagonists:** May increase INR and risk of bleeding; monitor coagulation status.
## Monitoring
* Signs of resolution of infection.
* Monitor for signs of *C. difficile* (persistent diarrhea).
* Biliary ultrasound if biliary obstruction is suspected.
* Prothrombin time (PT/INR) in patients at high risk of vitamin K deficiency or on anticoagulants.
## Clinical Pearls
* Ceftriaxone has no activity against *Enterococcus* species, *Listeria monocytogenes*, or MRSA.
* IM administration is painful; consider reconstitution with 1% lidocaine (without epinephrine) for patient comfort unless contraindicated.
* Always consult institutional antibiogram/local protocols for empirical choices, as regional resistance patterns vary significantly.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify dosages, contraindications, and drug interactions using current institutional protocols and formal drug reference databases (e.g., Lexicomp, UpToDate) before prescribing.*
