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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. It is administered intravenously or intramuscularly.
## Primary Indications
* Pneumonia (community-acquired)
* Meningitis
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Sepsis
* Gonorrhea (uncomplicated)
* Surgical prophylaxis
## Adult Dosing
* **General:** 1 to 2 grams intravenously (IV) or intramuscularly (IM) every 12 to 24 hours.
* **Maximum:** 4 grams daily.
* **Uncomplicated Gonorrhea:** 250 mg IM once.
* **Meningitis:** 2 grams IV every 12 hours.
* **Surgical Prophylaxis:** 1 to 2 grams IV 30 to 60 minutes before incision.
Dosing for specific indications may vary based on severity and local guidelines.
## Pediatric Dosing
* **General:** 50 to 100 mg/kg IV or IM divided every 12 to 24 hours.
* **Maximum:** 2 grams daily for infants and children up to 12 years. For neonates (0-14 days), the maximum dose is 50 mg/kg/day.
* **Meningitis:** 100 mg/kg IV divided every 12 hours (maximum 4 grams daily).
* **Neonates (0-14 days):** 25 to 50 mg/kg IV every 24 hours.
Dosing for neonates requires careful consideration due to immature renal and hepatic function. Consult pediatric infectious disease resources or local protocols.
## Dose Adjustments
No specific dose adjustment is typically required for hepatic impairment. In patients with severe renal impairment (creatinine clearance < 10 mL/min), the daily dose may be reduced by one-half, but the same dosing interval should be maintained. In patients with both hepatic and severe renal impairment, doses similar to those recommended for severe renal impairment alone are usually sufficient.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or any component of the formulation.
* Neonates (gestational age ≤ 41 weeks) receiving IV calcium-containing solutions or infusions due to the risk of precipitation.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, injection site reactions (pain, phlebitis).
* **Serious:**
* **Hypersensitivity reactions:** Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
* **Clostridioides difficile-associated diarrhea (CDAD).**
* **Biliary pseudolithiasis:** Especially in neonates and children.
* **Hematologic effects:** Eosinophilia, leukopenia, thrombocytopenia, hemolytic anemia.
* **Renal:** Interstitial nephritis.
* **Hepatic:** Elevated liver enzymes.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially with prolonged coadministration.
* **Warfarin:** Ceftriaxone may alter the anticoagulant response. Monitor INR closely.
* **Probenecid:** May increase and prolong ceftriaxone plasma concentrations.
* **Calcium-containing solutions/products (IV):** Contraindicated in neonates. Concurrent use in adults may increase risk of precipitation in lungs and kidneys; separate administration by at least 48 hours or avoid if possible.
## Monitoring
* Signs and symptoms of infection.
* Renal and hepatic function.
* Signs of hypersensitivity reactions.
* Electrolytes.
* Signs of CDAD.
* In neonates, monitor for signs of biliary precipitation.
## Clinical Pearls
* Ceftriaxone's long half-life allows for once or twice daily dosing.
* Reconstituted solutions for IV administration should be protected from light.
* IM injections may be painful; consider lidocaine as a diluent (not for IV use).
* Avoid concurrent use of calcium-containing IV fluids in neonates.
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**Disclaimer:** This information is intended for healthcare professionals and should not replace clinical judgment. Always consult the official prescribing information and relevant guidelines for complete details before making treatment decisions. Dosing can vary significantly based on patient-specific factors and institutional protocols.
