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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.
## Primary Indications
* Pneumonia
* Meningitis
* Bacterial sepsis
* Uncomplicated gonorrhea
* Urinary tract infections
* Skin and soft tissue infections
* Bone and joint infections
* Perioperative prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe infections:** 2 grams IV every 12 hours (maximum daily dose is 4 grams).
* **Uncomplicated gonorrhea:** 500 mg IM single dose. For disseminated gonococcal infection, 1 gram IV or IM every 24 hours for 7 days.
* **Surgical prophylaxis:** 1 to 2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg/day IV or IM every 24 hours. Do not exceed 50 mg/kg/day.
* **Neonates (15-28 days) and children < 50 kg:** 50-100 mg/kg/day IV or IM divided every 12 or 24 hours (depending on indication, specific local protocol is often followed for dosage frequency). Maximum daily dose is 4 grams.
* **Children ≥ 50 kg:** Adult dosing.
* **Meningitis:** 100 mg/kg/day IV divided every 12 or 24 hours (maximum 4 grams/day). Treatment duration varies by pathogen.
## Dose Adjustments
No dose adjustment is necessary for renal or hepatic impairment. However, in severe hepatic or renal dysfunction, monitoring may be warranted.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates receiving IV calcium-containing solutions or requiring continuous infusion via a TPN line due to risk of precipitate formation.
## Adverse Effects
* Diarrhea
* Rash
* Eosinophilia
* Thrombocytosis
* Elevated liver enzymes
* Phlebitis (IV administration)
* Pain at injection site (IM administration)
* Biliary sludge/cholelithiasis (especially in neonates and with prolonged therapy)
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with concurrent use for severe infections.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin. Monitor INR.
* **Calcium-containing solutions:** Contraindicated in neonates. Potential for precipitate formation in IV lines and in vivo.
## Monitoring
* Signs and symptoms of infection
* Renal and hepatic function (baseline and periodically)
* Complete blood count (periodically)
* INR if patient is on warfarin
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once-daily dosing in many indications.
* IM administration can be painful; consider lidocaine as a diluent if reconstituting IM.
* May cause a false-positive Coombs' test.
* Biliary sludging is a known phenomenon, particularly in pediatric populations; ultrasound monitoring may be considered in at-risk patients.
*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for the most up-to-date and comprehensive details before making any treatment decisions.*
