Ceftriaxone (Rocephin)

Prophylaxis timing - Give within 60 minutes before incision; long half-life usually means no intraoperative redose is needed.

Calcium incompatibility - Do not co-administer with IV calcium-containing solutions (including LR) through the same line in neonates; fatal precipitates have occurred. In older patients, sequence and flush lines between them.

Anaphylaxis readiness - Keep epinephrine and airway support available.

Drug Interactions - Physically incompatible with calcium-containing IV fluids; additive effect with other nephrotoxins is minimal.

Pediatric Implications - Weight-based (50-75 mg/kg, max 2 g); avoid in neonates receiving IV calcium and in hyperbilirubinemic neonates (displaces bilirubin).

Obstetric Implications - Category B, crosses the placenta; commonly used peripartum. Compatible with breastfeeding.

Absolute:

Neonates (<28 days) requiring IV calcium-containing solutions

Hyperbilirubinemic neonates

Relative:

Severe/anaphylactic penicillin allergy

Caution:

Biliary disease

Concurrent IV calcium in older patients

Surgical prophylaxis: 2 g IV within 60 min of incision (adult); 50-75 mg/kg, max 2 g (pediatric).

Long half-life; intraoperative redosing generally not required.

1-2 g IM, reconstituted with lidocaine to reduce injection pain, when IV access is unavailable.

Binds penicillin-binding proteins to inhibit bacterial cell-wall synthesis; resistant to many beta-lactamases.

None (not metabolized)

Renal and biliary

Give slow IV push over 2-4 min or infusion. Never mix with calcium-containing solutions.