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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
* Complicated skin and skin structure infections (cSSSI)
* Biliary tract infections
* Uncomplicated gonorrhea
* Pneumonia (community-acquired and hospital-acquired)
* Meningitis (bacterial)
* Sepsis
* Prophylaxis for surgical procedures
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 12-24 hours depending on severity and infection type.
* **Uncomplicated gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infection, 1 gram IV/IM every 24 hours for 7 days.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
* **Maximum dose:** 4 grams per day.
## Pediatric Dosing
* Dosing is weight-based and depends on the infection type and severity. Consult specific pediatric infectious disease guidelines.
* **General infections:** Doses typically range from 50-100 mg/kg/day IV/IM divided every 12-24 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
* **Neonates (0-14 days):** Maximum dose is 50 mg/kg/day IV divided every 24 hours due to risk of bilirubin displacement.
* **Neonates (15-28 days) and infants < 2 months:** Maximum dose is 80 mg/kg/day IV divided every 12-24 hours.
## Dose Adjustments
No specific dose adjustments are necessary for renal or hepatic impairment. However, monitor liver and kidney function, especially in patients with severe dysfunction.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving calcium-containing IV solutions (risk of precipitating ceftriaxone-calcium crystals).
## Adverse Effects
* Phlebitis (at IV site)
* Pain and induration (with IM injection)
* Diarrhea
* Rash
* Eosinophilia
* Elevated liver enzymes
* Hemolytic anemia (rare)
* Biliary sludge or pseudolithiasis (especially in pediatric patients)
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, particularly with prolonged concurrent use.
* **Warfarin:** May decrease the effect of warfarin, leading to increased INR. Monitor INR closely and consider dose adjustment of warfarin.
* **Probenecid:** Can increase and prolong ceftriaxone levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for gastrointestinal side effects, especially Clostridioides difficile infection.
* Monitor liver and renal function, particularly in patients with pre-existing conditions or on concurrent nephrotoxic agents.
* Monitor INR if co-administered with warfarin.
## Clinical Pearls
* Ceftriaxone is highly protein-bound, which can prolong its half-life and allow for once or twice-daily dosing.
* Do not mix ceftriaxone with calcium-containing solutions or administer them simultaneously through the same IV line, especially in neonates.
* IM injections are typically reconstituted with lidocaine to reduce pain.
* Ceftriaxone is a common choice for empiric treatment of community-acquired pneumonia and meningitis due to its broad spectrum.
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**Disclaimer:** This information is intended for educational purposes and does not substitute for professional medical advice. Always consult official prescribing information and current clinical practice guidelines for the most up-to-date and comprehensive drug information.
