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# Ceftriaxone (Ceftriaxone)
## Overview
Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic administered intravenously or intramuscularly.
## Primary Indications
* **Bacterial meningitis:** Empiric treatment and treatment of documented meningitis caused by susceptible organisms.
* **Pneumonia:** Community-acquired pneumonia and hospital-acquired pneumonia.
* **Skin and skin structure infections:** Uncomplicated and complicated.
* **Urinary tract infections:** Complicated.
* **Pelvic inflammatory disease.**
* **Gonorrhea:** Uncomplicated.
* **Sepsis and bacteremia.**
* **Surgical prophylaxis.**
## Adult Dosing
* **General:** 1-2 grams IV/IM every 12 or 24 hours.
* **Meningitis:** 2 grams IV every 12 hours. Higher doses (e.g., 4 grams IV daily) may be used in severe cases, divided every 8-12 hours.
* **Uncomplicated Gonorrhea:** 250 mg IM single dose.
* **Surgical Prophylaxis:** 1-2 grams IV 30-60 minutes before incision.
## Pediatric Dosing
* **Neonate (<28 days):** 25-50 mg/kg IV/IM every 24 hours. Avoid concurrent IV calcium-containing solutions.
* **Infants and Children (>28 days):** 50-100 mg/kg/day IV/IM divided every 12 or 24 hours. Maximum dose: 2 grams daily.
* **Meningitis (Pediatric):** 100 mg/kg/day IV divided every 12 hours. Maximum dose: 4 grams daily.
## Dose Adjustments
No dose adjustment is typically needed for renal impairment. For severe hepatic impairment or combined renal and hepatic impairment, dosing may need to be adjusted; consult guidelines.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (birth to 28 days) receiving IV calcium-containing solutions or infusions that include calcium.
## Adverse Effects
* **Common:** Diarrhea, rash, eosinophilia, thrombocytosis, phlebitis.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, cholelithiasis (biliary pseudolithiasis), hemolytic anemia, seizure.
## Key Drug Interactions
* **Aminoglycosides:** Potential for increased nephrotoxicity.
* **Warfarin:** May decrease INR. Monitor INR closely.
* **Live Typhoid Vaccine:** Ceftriaxone may decrease the efficacy of the vaccine.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function (especially in severe impairment).
* Blood counts.
* Prothrombin time/INR if on anticoagulants.
## Clinical Pearls
* Ceftriaxone is a frequent choice for empiric therapy due to its broad spectrum and favorable pharmacokinetic profile (long half-life allowing once or twice daily dosing).
* IM administration may cause pain and induration.
* Do not mix or administer ceftriaxone simultaneously with IV calcium-containing solutions, including parenteral nutrition, in neonates.
* Ceftriaxone has good penetration into the cerebrospinal fluid, making it a preferred agent for bacterial meningitis.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions. Dosing may vary based on specific clinical circumstances and local guidelines.*
