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# Ceftriaxone (Ceftriaxone)
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-positive and Gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Uncomplicated gonorrhea
* Pelvic inflammatory disease
* Bacterial meningitis (alternative)
* Sepsis
* Intra-abdominal infections
* Skin and soft tissue infections
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Severe Infections:** Up to 4 grams IV every 24 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM single dose. Disseminated gonococcal infection: 1 gram IV/IM every 24 hours for 7 days.
* **Meningitis:** 2 grams IV every 12 hours. Duration varies by pathogen (e.g., 7 days for *Streptococcus pneumoniae*, 10-14 days for *Haemophilus influenzae*).
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV every 24 hours. Do not exceed 125 mg/day.
* **Neonates (15-28 days):** 25-50 mg/kg IV every 12 hours.
* **Children > 15 days:**
* **Uncomplicated Infections:** 50-75 mg/kg IV/IM every 12 to 24 hours.
* **Severe Infections:** Up to 100 mg/kg/day IV/IM divided every 8-12 hours. Maximum 2 grams/day.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours. Maximum 4 grams/day.
## Dose Adjustments
No dose adjustment is necessary for renal or hepatic impairment. However, in severe hepatic impairment with absent or impaired renal function, the total daily dose should not exceed 2 grams.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 28 days gestational or chronological age) receiving IV calcium-containing solutions or infusions. Fatal reactions have occurred with concomitant IV ceftriaxone and calcium-containing products due to precipitation.
## Adverse Effects
* Diarrhea (most common)
* Rash
* Eosinophilia
* Thrombocytosis
* Phlebitis
* Jaundice
* Biliary sludge/pseudolithiasis (especially in neonates)
* Hypoprothrombinemia
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity or ototoxicity when used together, especially in severe infections. Monitor renal function and drug levels.
* **Probenecid:** May increase and prolong ceftriaxone serum concentrations.
* **Warfarin:** Ceftriaxone may interfere with vitamin K synthesis, potentially increasing the anticoagulant effect of warfarin. Monitor INR closely.
* **Calcium-containing solutions:** Contraindicated in neonates (see Contraindications). Caution advised in adults and other pediatric populations, though data suggests concurrent administration via separate lines is generally safe.
## Monitoring
* Renal and hepatic function (baseline and periodic, especially if risk factors present).
* Signs and symptoms of infection.
* Signs and symptoms of allergic reaction.
* INR if patient is on warfarin.
* For neonates, monitor for signs of biliary sludge.
## Clinical Pearls
* Ceftriaxone is typically administered every 12 or 24 hours, which can simplify dosing regimens.
* It is a common choice for empiric treatment of many infections due to its broad spectrum.
* IM injection can be painful; consider co-administration with lidocaine (without epinephrine) for IM injections, though this is not FDA-approved and requires careful consideration.
* The risk of biliary abnormalities is higher in neonates and preterm infants.
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*Disclaimer: This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.*
