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# Ceftriaxone (Rocephin)
## 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 infections:** Pneumonia, meningitis, gonorrhea, skin and soft tissue infections, bone and joint infections, intra-abdominal infections, sepsis.
* **Prophylaxis:** Surgical site infection prophylaxis.
## Adult Dosing
* **General Infections:** 1-2 grams intravenously (IV) or intramuscularly (IM) every 12 or 24 hours. Doses up to 4 grams per day may be used for severe infections.
* **Meningitis:** 2 grams IV every 12 hours.
* **Gonorrhea (uncomplicated):** 500 mg IM administered as a single dose.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes before surgical incision.
## Pediatric Dosing
* **Neonates (<7 days):** 25-50 mg/kg IV or IM every 12 or 24 hours. **Do not exceed 50 mg/kg/day.**
* **Children (>7 days, <125 kg):**
* **Uncomplicated infections:** 50-100 mg/kg/day IV or IM divided every 12 or 24 hours.
* **Severe infections:** 50-100 mg/kg/day IV or IM divided every 8 or 12 hours. **Maximum daily dose is 2 grams.**
* **Meningitis:** 100 mg/kg/day IV divided every 12 or 24 hours. **Maximum daily dose is 4 grams.**
* **Children (>125 kg):** Use adult dosing.
## Dose Adjustments
No dose adjustment is necessary for adult or pediatric patients with renal or hepatic impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* **Neonates (term and preterm):** Use of IV ceftriaxone is contraindicated in neonates receiving concurrent treatment with calcium-containing IV solutions or products due to the risk of precipitate formation.
## Adverse Effects
* **Common:** Diarrhea, rash, phlebitis at the injection site.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary pseudolithiasis (especially in children), thrombocytopenia, hemolytic anemia, renal calculi.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity and ototoxicity, particularly in severe infections. Monitor drug levels and renal function.
* **Warfarin:** Ceftriaxone may decrease the effect of warfarin; monitor INR closely.
* **Probenecid:** Probenecid may increase ceftriaxone levels; typically not clinically significant and not usually managed by dose adjustment.
* **Calcium-containing solutions/products:** Contraindicated in neonates receiving IV ceftriaxone.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function, though dose adjustment is not typically required.
* For patients on warfarin, monitor INR.
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice daily dosing.
* It is often used for empiric treatment of community-acquired pneumonia, meningitis, and febrile neutropenia.
* For IM administration, lidocaine can be used to dilute ceftriaxone to reduce injection pain. Do NOT use lidocaine for IV administration.
* Ensure adequate hydration to minimize the risk of renal calculi.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines for complete details.*
