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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 intravenously or intramuscularly.
## Primary Indications
* Bacterial meningitis
* Pneumonia (community-acquired and hospital-acquired)
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Intra-abdominal infections
* Septicemia
* Gonorrhea and syphilis
## Adult Dosing
* **General infections:** 1 to 2 grams IV or IM every 24 hours.
* **Severe infections:** Doses up to 4 grams IV per day, divided into two 2-gram doses every 12 hours.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated gonorrhea:** 250 mg IM once.
* **Syphilis (early):** 2.4 grams IM once, or 800 mg IM every 3 days for 3 doses in penicillin-allergic patients.
* **Syphilis (late/tertiary):** 2.4 grams IM every 3 days for 3 doses.
## Pediatric Dosing
* **Meningitis:** 100 mg/kg IV every 24 hours. Higher doses may be required for severe infections. Maximum dose is often 4 grams daily, but local protocols may vary.
* **Other infections:** 50 to 100 mg/kg IV or IM every 24 hours, not to exceed 2 grams daily.
* **Neonates (0-14 days):** 25 to 50 mg/kg IV every 24 hours.
* **Neonates (15-28 days):** 50 mg/kg IV every 24 hours.
* **Note:** Dosing for neonates should be carefully considered due to immature hepatic and renal function. Hyperbilirubinemic neonates should not receive IV ceftriaxone.
## Dose Adjustments
No dose adjustment is typically needed for renal impairment unless concomitant hepatic impairment is present. In severe renal impairment without hepatic impairment, the dose may be reduced, but this is often not necessary due to biliary excretion.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates with hyperbilirubinemia or receiving IV calcium-containing solutions.
## Adverse Effects
* Hypersensitivity reactions (rash, anaphylaxis)
* Gastrointestinal upset (diarrhea, nausea)
* Thrombocytosis, eosinophilia, leukopenia
* Elevated liver enzymes
* Phlebitis at the injection site
* Biliary sludge or pseudolithiasis (especially in children)
* Jarisch-Herxheimer reaction (especially with syphilis treatment)
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially in severe renal impairment.
* **Oral anticoagulants (e.g., warfarin):** May enhance anticoagulant effect due to vitamin K deficiency.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions:** Contraindicated in neonates due to risk of precipitate formation.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of superinfection.
* Monitor liver enzymes and renal function periodically, especially with prolonged therapy or in patients with pre-existing conditions.
* Monitor for biliary sludge or signs of obstruction if symptoms develop.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing in most cases, enhancing patient compliance.
* IM administration is often preferred for outpatient use, but the injection can be painful. Adding lidocaine to the diluent may mitigate pain.
* IV administration requires reconstitution and may be administered as a bolus or infusion.
* Biliary pseudolithiasis is a common, usually asymptomatic finding, particularly in pediatric patients. Reversible upon discontinuation of the drug.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information or a qualified healthcare provider for any questions regarding medications.*
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