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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Pneumonia (community-acquired)
* Meningitis (bacterial, especially *Neisseria meningitidis*)
* Skin and soft tissue infections
* Urinary tract infections (complicated)
* Gonorrhea and Pelvic Inflammatory Disease
* Bacterial sepsis
* Surgical prophylaxis
## Adult Dosing
* **General Infections:** 1 to 2 grams IV/IM every 24 hours. Doses up to 4 grams daily have been used for severe infections.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose (1 gram for disseminated gonococcal infections).
* **Surgical Prophylaxis:** 1 to 2 grams IV/IM 30-60 minutes prior to incision.
## Pediatric Dosing
* **Infants < 7 days:** 25-50 mg/kg IV/IM every 24 hours.
* **Infants 7 days to < 2 years:** 50-75 mg/kg IV/IM every 24 hours. Maximum 2 grams daily.
* **Children ≥ 2 years:** 50-100 mg/kg IV/IM every 24 hours. Maximum 2 grams daily.
* **Meningitis (Pediatric):** 100 mg/kg IV every 12 hours. Maximum 4 grams daily.
*Note: Specific dosing may vary based on the local protocol and the severity of infection.*
## Dose Adjustments
No dose adjustment is typically required for renal impairment. However, if severe renal impairment is present with hepatic dysfunction, may need dose reduction.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 28 days) receiving IV calcium-containing solutions or infusions due to risk of precipitation.
## Adverse Effects
* Diarrhea
* Rash, pruritus
* Eosinophilia, thrombocytosis, leukopenia
* Local reactions (pain, phlebitis at injection site)
* Biliary pseudolithiasis (e.g., sludge)
## Key Drug Interactions
* **Calcium-containing solutions:** Concurrent IV administration can lead to precipitation, especially in neonates. Do not mix or co-infuse ceftriaxone with calcium-containing solutions.
* **Aminoglycosides:** Potential for additive nephrotoxicity, monitor renal function closely.
* **Probenecid:** May increase ceftriaxone levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for development of Clostridioides difficile-associated diarrhea.
* Consider monitoring renal and liver function, especially with prolonged therapy or in patients with pre-existing dysfunction.
* Biliary sludge monitoring is recommended in pediatric patients and for prolonged treatment courses.
## Clinical Pearls
* Ceftriaxone achieves therapeutic concentrations in cerebrospinal fluid, making it a drug of choice for bacterial meningitis.
* Its long half-life allows for once-daily dosing, improving patient compliance.
* Administer IM injections deep into a large muscle mass. IV administration can be given as a bolus or over 30 minutes.
* Do not use in neonates receiving parenteral calcium.
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*This information is intended for clinical use and does not replace the official prescribing information or professional medical advice. Always verify current prescribing information and consult with a healthcare professional before making any treatment decisions.*
