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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
* Pneumonia (community-acquired, hospital-acquired)
* Bacterial meningitis
* Sepsis
* Skin and soft tissue infections
* Urinary tract infections
* Intra-abdominal infections
* Gonorrhea and its complications
* Prophylaxis for surgical procedures
## Adult Dosing
* **General infections:** 1-2 grams IV/IM every 12 to 24 hours. Maximum daily dose is typically 4 grams.
* **Serious infections:** Up to 2 grams IV every 12 hours. Maximum daily dose is typically 4 grams.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated gonorrhea:** 500 mg IM single dose.
* **Disseminated gonococcal infection:** 1 gram IV/IM every 12 hours for 7 days.
* **Surgical prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
Specific dosing for certain indications may be guided by local protocols.
## Pediatric Dosing
Dosing in neonates and children is based on weight and age. Refer to specific pediatric guidelines.
* **Neonates (0-14 days):** Doses should not exceed 50 mg/kg/day to avoid bilirubin displacement. Typically 25-50 mg/kg/day IV/IM divided every 12 or 24 hours.
* **Neonates (15-28 days):** 50 mg/kg/day IV/IM divided every 12 or 24 hours.
* **Infants and children (>28 days to 12 years):** 50-100 mg/kg/day IV/IM divided every 12 or 24 hours. Maximum daily dose is 2 grams.
* **Children >12 years or weighing >50 kg:** Adult doses.
* **Meningitis in children:** 100 mg/kg/day IV divided every 12 hours. Maximum daily dose is 4 grams.
## Dose Adjustments
No dose adjustment is typically required for renal impairment. However, in severe hepatic impairment with concurrent renal impairment, caution and consideration for dose reduction may be necessary; however, data is limited.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates with hyperbilirubinemia, especially those who are premature, should not receive IV ceftriaxone, particularly if they require concurrent (or are expected to require) calcium-containing fluid infusions or parenteral nutrition due to the risk of ceftriaxone-calcium precipitates in the lungs and kidneys.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, injection site reactions (pain, phlebitis).
* **Serious:** Anaphylaxis, Stevens-Johnson syndrome, C. difficile-associated diarrhea, biliary sludge or pseudolithiasis (especially in neonates and children), eosinophilia, thrombocytosis, leukopenia.
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** Ceftriaxone may alter the effect of warfarin; monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone serum levels.
* **Calcium-containing solutions/products:** Contraindicated in neonates (see Contraindications). In adults, concurrent administration via separate lines is generally considered safe, but avoid simultaneous administration and monitor for precipitates.
## Monitoring
* Renal and hepatic function.
* Signs and symptoms of infection.
* Blood counts.
* Signs of hypersensitivity reactions.
* For patients on warfarin, monitor INR.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing.
* It is often preferred for outpatient parenteral antibiotic therapy (OPAT) due to its dosing frequency and IM administration option.
* Ensure adequate hydration during treatment.
* Biliary sludging is a common, usually benign, finding, particularly in children, and typically resolves after discontinuation.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines for definitive patient care decisions.*
