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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 organisms. It is administered intravenously or intramuscularly.
## Primary Indications
* **Serious bacterial infections:** Including meningitis, pneumonia, skin and soft tissue infections, urinary tract infections, bone and joint infections, intra-abdominal infections, gonorrhea, and septicemia.
* **Surgical prophylaxis:** Commonly used for prophylaxis in various surgical procedures.
## Adult Dosing
* **General Infections:** 1 to 2 grams (g) intravenously (IV) or intramuscularly (IM) every 24 hours.
* **Severe Infections:** Doses up to 4 g IV daily, divided into two doses (every 12 hours), have been used.
* **Uncomplicated Gonorrhea:** 250 mg IM as a single dose.
* **Surgical Prophylaxis:** 1 to 2 g IV or IM within 1 hour of incision.
## Pediatric Dosing
* **Neonates (< 2 weeks):** 25-50 mg/kg IV every 24 hours.
* **Neonates (2-4 weeks):** 50 mg/kg IV every 24 hours.
* **Children (> 4 weeks):**
* **General Infections:** 50-100 mg/kg/day IV or IM divided every 12-24 hours.
* **Severe Infections:** Up to 120 mg/kg/day IV divided every 12 hours.
* **Meningitis:** 100 mg/kg/day IV divided every 12 hours.
* **Maximum pediatric dose:** Generally 4 g/day. Specific indications may have higher maximums (e.g., meningitis).
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is necessary in patients with moderate to severe renal impairment if hepatic function is normal. However, monitoring may be warranted.
* **Hepatic Impairment:** No dose adjustment is necessary in patients with hepatic impairment if renal function is normal.
* **Combined Renal and Hepatic Impairment:** Maximum dose should not exceed 2 g daily.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (≤ 41 weeks post-menstrual age) receiving IV calcium-containing solutions or infusions.
## Adverse Effects
* **Common:** Diarrhea, rash, injection site reactions (pain, phlebitis), eosinophilia, thrombocytosis.
* **Serious:** *Clostridioides difficile*-associated diarrhea, biliary sludging (especially in neonates), hemolytic anemia, Stevens-Johnson syndrome, anaphylaxis.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, particularly with high doses. Monitor renal function.
* **Probenecid:** Can increase and prolong ceftriaxone levels.
* **Oral anticoagulants (e.g., warfarin):** Ceftriaxone may potentiate the effect of oral anticoagulants. Monitor INR.
* **Calcium-containing solutions:** Avoid concomitant administration, especially IV, in neonates due to risk of precipitation and potentially fatal cardiorespiratory events.
## Monitoring
* Assess for signs and symptoms of infection and improvement.
* Monitor for adverse effects, including hypersensitivity reactions, diarrhea, and injection site reactions.
* Consider baseline and periodic renal and hepatic function tests, complete blood count, and coagulation studies if prolonged therapy or risk factors exist.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once-daily dosing in many cases.
* For IM administration, reconstitute with the appropriate diluent as per manufacturer's instructions. Avoid lidocaine for reconstitution in neonates and infants.
* Ceftriaxone can cause reversible biliary sludging, which is more common in neonates and children receiving high doses. This is usually asymptomatic and resolves after discontinuation.
* Due to a lack of data, avoid ceftriaxone in neonates (≤41 weeks post-menstrual age) treated concurrently with certain IV calcium-containing products.
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*This information is intended for clinical pharmacists and should not be considered a substitute for professional medical advice. Always consult the most current prescribing information and institutional protocols before making any treatment decisions.*
