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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
* Bacterial meningitis
* Community-acquired pneumonia
* Skin and skin structure infections
* Urinary tract infections
* Intra-abdominal infections
* Gonorrhea and disseminated gonococcal infections
* Sepsis
## Adult Dosing
* **General Infections:** 1-2 grams IV/IM every 24 hours. Higher doses may be needed for severe infections.
* **Meningitis:** 2 grams IV every 12 hours.
* **Gonorrhea:** 500 mg IM single dose. For disseminated gonococcal infections, 1 gram IV/IM every 24 hours for 7-10 days.
* **Surgical Prophylaxis:** 1-2 grams IV/IM 30-60 minutes prior to incision.
* **Maximum Dose:** 4 grams IV/IM per 24 hours.
## Pediatric Dosing
* **Neonates (0-14 days):** 25-50 mg/kg IV/IM every 24 hours. Avoid concurrent IV calcium-containing solutions.
* **Neonates (>14 days) and Children:** 50-100 mg/kg IV/IM every 24 hours.
* **Meningitis:** 80-100 mg/kg IV every 12-24 hours.
* **Maximum Dose (Pediatric):** 2 grams IV/IM every 24 hours. Dosing may depend on local protocol for specific indications.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment. However, monitor closely in severe impairment.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (less than 28 days) receiving IV calcium-containing solutions or via continuous infusion due to risk of precipitates.
## Adverse Effects
* Diarrhea, nausea, vomiting
* Rash, pruritus
* Eosinophilia, thrombocytosis, leukopenia
* Elevated liver enzymes
* Injection site pain or phlebitis
* Biliary sludging (especially in children)
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity (synergistic effect).
* **Warfarin:** May alter INR; monitor closely.
* **Probenecid:** May increase ceftriaxone levels.
* **Calcium-containing solutions:** Contraindicated in neonates; avoid in adults if possible, especially via the same IV line.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function periodically.
* Complete blood count.
* Prothrombin time/INR if patient is on anticoagulants.
* Monitor for signs of allergic reactions.
## Clinical Pearls
* Ceftriaxone has a long half-life allowing for once-daily dosing.
* Can be administered IM without lidocaine in adults if needed, though lidocaine can reduce injection site pain.
* The presence of biliary sludging in pediatric patients is usually transient and asymptomatic; often resolves after discontinuation of the drug.
* **Crucial:** Never use ceftriaxone solution containing lidocaine for intravenous administration. Only use for IM injection.
Please verify current prescribing information with the latest official drug monograph or guideline.
