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# Ceftriaxone (ceftriaxone)
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic indicated for the treatment of various bacterial infections. It is administered via intramuscular (IM) or intravenous (IV) routes.
## Primary Indications
* Community-acquired pneumonia
* Acute bacterial meningitis (unless contraindicated)
* Bacterial endocarditis
* Gonorrhea (uncomplicated)
* Early Lyme disease (stage 1 disseminated)
* Skin and skin structure infections
* Bone and joint infections
* Intra-abdominal infections
* Febrile neutropenia
## Adult Dosing
* **General Infections:** 1 to 2 grams IV/IM every 24 hours.
* **Meningitis:** 2 grams IV every 12 hours (total 4 grams daily).
* **Gonorrhea:** 250 mg IM once.
* **Lyme Disease (Stage 1 Disseminated):** 1 gram IV/IM every 24 hours for 14 days.
* **Maximum Dose:** 4 grams IV/IM every 24 hours.
Dosing for specific indications may vary based on severity and causative pathogen.
## Pediatric Dosing
* **General Infections:** 50 to 100 mg/kg IV/IM every 24 hours.
* **Meningitis:** 80 to 100 mg/kg IV every 12 hours.
* **Maximum Dose:** 4 grams IV/IM every 24 hours.
* **Neonates (0-14 days):** 25 to 50 mg/kg IV/IM every 24 hours. Avoid IV use with calcium-containing solutions in neonates due to risk of precipitate formation.
Dosing in neonates and infants requires careful consideration of gestational and chronological age.
## Dose Adjustments
No dose adjustment is generally required for renal or hepatic impairment. However, extreme caution and consideration for dose reduction may be warranted in severe hepatic and renal dysfunction concurrently.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates (less than 28 days old) receiving IV ceftriaxone and concurrent IV calcium-containing solutions or infusions due to the risk of fatal ceftriaxone-calcium precipitates in the lungs and kidneys.
## Adverse Effects
* **Common:** Diarrhea, rash, eosinophilia, thrombocytosis, leukopenia, injection site reactions (pain, phlebitis).
* **Serious:** *Clostridioides difficile*-associated diarrhea, anaphylaxis, seizures, biliary sludge/pseudolithiasis, hemolytic anemia, interstitial nephritis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with higher doses or prolonged therapy.
* **Probenecid:** May increase and prolong ceftriaxone serum concentrations.
* **Warfarin:** Ceftriaxone may alter the response to warfarin. Monitor INR closely.
* **Calcium-containing solutions/products:** Fatal precipitate formation in neonates when co-administered intravenously.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for effectiveness (clinical improvement, resolution of signs/symptoms of infection).
* Monitor for adverse effects, including GI distress and signs of *C. difficile* infection.
* Monitor prothrombin time/INR if patient is on warfarin.
* Consider monitoring biliary function if prolonged therapy or risk factors for biliary sludge exist.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing in most adult indications.
* It penetrates the blood-brain barrier effectively, making it a primary choice for bacterial meningitis.
* Caution is advised in patients with a history of penicillin allergy, though cross-reactivity is generally low (<1-2%).
* IV administration can be painful; consider lidocaine vehicle for IM injections if available and appropriate per local protocol.
* Rarely, ceftriaxone can form precipitates with calcium in the urine or gallbladder, which are typically asymptomatic but can be mistaken for stones.
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***Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the current prescribing information and relevant clinical guidelines, as well as institutional protocols, for complete and up-to-date guidance before initiating or modifying therapy.*
