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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 bacteria. It has a long half-life, allowing for once-daily dosing.
## Primary Indications
* Pneumonia
* Meningitis (including Neisseria meningitidis)
* Bone and joint infections
* Intra-abdominal infections
* Skin and soft tissue infections
* Urinary tract infections
* Gonorrhea
* Sepsis
## Adult Dosing
* **General Infections:** 1 to 2 grams IV or IM every 24 hours.
* **Severe Infections:** Up to 4 grams IV daily, divided every 12 hours (though once-daily dosing is preferred for most indications).
* **Uncomplicated Gonorrhea:** 250 mg IM single dose.
* **Disseminated Gonococcal Infections:** 1 gram IV or IM every 24 hours for 7 days.
* **Meningitis:** 2 grams IV every 24 hours. Dosing may be guided by local guidelines for specific pathogens.
## Pediatric Dosing
* **Neonates (< 7 days):** 25 to 50 mg/kg IV every 24 hours. Do not exceed 50 mg/kg.
* **Infants and Children (> 7 days and < 125 kg):**
* **General Infections:** 50 to 75 mg/kg IV or IM every 24 hours.
* **Severe Infections:** Up to 100 mg/kg/day IV, divided every 12 to 24 hours (maximum 2 grams/day).
* **Meningitis:** 80 to 100 mg/kg/day IV, divided every 12 to 24 hours (maximum 4 grams/day). Dosing may be guided by local guidelines for specific pathogens.
* **Children > 12 years (and adult weight):** Adult dosing.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is generally required due to extensive hepatic excretion.
* **Hepatic Impairment:** No dose adjustment is generally required.
* **Combined Renal and Hepatic Impairment:** Use with caution.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (term and preterm) receiving IV calcium-containing solutions or infusions. This is due to the risk of precipitation of ceftriaxone-calcium.
## Adverse Effects
* Phlebitis (with IV administration)
* Eosinophilia, thrombocytosis, leukopenia
* Diarrhea
* Rash, pruritus
* Increased liver enzymes
* Gallbladder sludge and pseudolithiasis (especially in children)
* Nephrotoxicity (rare)
* Anaphylaxis (rare)
## Key Drug Interactions
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **Warfarin:** May alter the anticoagulant effect. Monitor INR closely.
* **Probenecid:** May increase ceftriaxone levels.
* **Calcium-containing products:** Contraindicated in neonates; avoid concurrent administration in adults if possible.
## Monitoring
* Signs and symptoms of infection
* Renal and hepatic function (baseline and periodically, especially with prolonged therapy)
* Complete blood count (especially if prolonged therapy)
* Culture and sensitivity results
## Clinical Pearls
* Ceftriaxone is often considered a drug of choice for community-acquired pneumonia, acute otitis media, and uncomplicated gonorrhea.
* Due to its long half-life, it is typically administered once daily.
* The risk of gallbladder pseudolithiasis is higher with higher doses and longer duration of therapy, particularly in pediatric patients. Discontinuation of ceftriaxone may lead to resolution of this finding.
* When reconstituting, use appropriate diluents as per manufacturer instructions.
* Ensure adequate hydration to minimize the risk of crystalluria.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before making clinical decisions.
