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# Ceftriaxone (Ceftriaxone)
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is administered via intravenous or intramuscular routes.
## Primary Indications
* Bacterial meningitis (community-acquired and healthcare-associated)
* Pneumonia (community-acquired and healthcare-associated)
* Skin and soft tissue infections
* Urinary tract infections, including pyelonephritis
* Pelvic inflammatory disease
* Sepsis
* Bone and joint infections
* Gonorrhea (uncomplicated)
* Prophylaxis for surgical site infections
## Adult Dosing
* **General Infections:** 1-2 grams every 12 or 24 hours.
* **Meningitis:** 2 grams every 12 hours.
* **Sepsis:** 2 grams every 12 or 24 hours.
* **Surgical Prophylaxis:** 2 grams administered 30-60 minutes prior to incision.
* **Gonorrhea:** 500 mg IM single dose (1 gram for disseminated gonococcal infection).
* **Maximum Daily Dose:** 4 grams.
Dosing frequency and duration depend on the site and severity of infection, and local antimicrobial susceptibility patterns.
## Pediatric Dosing
* **Neonates (< 28 days):** 25-50 mg/kg once daily. Avoid concomitant IV calcium-containing solutions. Maximum dose is generally 50 mg/kg/day.
* **Older Children (> 28 days):** 50-100 mg/kg once or twice daily.
* **Meningitis:** 100 mg/kg every 12 or 24 hours (once daily may be sufficient for susceptible organisms in non-neonates).
* **Maximum Daily Dose:** 4 grams.
Specific pediatric dosing may vary based on indication and local protocols.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment needed as ceftriaxone is extensively eliminated by the liver and excreted in bile.
* **Hepatic Impairment:** No dose adjustment needed.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* **Neonates (term and premature):** Do not administer with intravenous calcium-containing solutions, including continuous infusions of parenteral nutrition, due to risk of fatal precipitation in lungs and kidneys.
## Adverse Effects
* **Common:** Diarrhea, rash, eosinophilia, thrombocytosis, leukopenia.
* **Serious:** Pseudomembranous colitis, biliary sludge or pseudolithiasis (especially in pediatric patients), anaphylaxis, Stevens-Johnson syndrome, hemolytic anemia, aplastic anemia, interstitial nephritis.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity, monitor renal function.
* **Warfarin:** Ceftriaxone may alter vitamin K metabolism, potentially affecting INR. Monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone levels (rarely used in current practice).
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile infection.
* Monitor renal and hepatic function, although significant alterations are uncommon.
* In neonates, monitor for signs of biliary sludge or precipitation.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing in many indications.
* It is a common choice for empiric treatment of serious bacterial infections.
* Intramuscular administration may be painful; consider lidocaine as diluent for IM injections.
* When reconstituting, follow manufacturer's guidelines carefully regarding diluent and volume.
* The risk of biliary pseudolithiasis is higher with higher doses and longer durations of therapy, and in pediatric patients. This is usually transient and asymptomatic.
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**Disclaimer:** This information is intended for educational purposes only and does not constitute medical advice. Always consult the most current prescribing information and applicable guidelines before making any clinical decisions. Drug information can change rapidly.
