From the FDA Drug Label
The total dose of sulbactam should not exceed 4 grams per day. The recommended adult dosage of ampicillin and sulbactam for injection is 1.5 g (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt) to 3 g (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt) every six hours. Compared to that in healthy adult subjects, the pharmacokinetics of ceftriaxone were only minimally altered in elderly subjects and in patients with renal impairment or hepatic dysfunction (Table 4); therefore, dosage adjustments are not necessary for these patients with ceftriaxone dosages up to 2 grams per day
The maximum dose of ceftriaxone is 2 grams per day 1 and the maximum dose of sulbactam is 4 grams per day 2.
- Ceftriaxone: 2 grams per day
- Sulbactam: 4 grams per day However, the maximum dose of the combination ceftriaxone-sulbactam is not explicitly stated in the provided drug labels.
From the Research
The maximum dose of ceftriaxone-sulbactam is typically 2 grams of ceftriaxone combined with 1 gram of sulbactam, administered intravenously every 12 hours, with adjustments for severe infections and renal impairment. When considering the treatment of infections, particularly those caused by beta-lactamase producing bacteria, the combination of ceftriaxone and sulbactam offers enhanced coverage, with ceftriaxone targeting gram-negative and some gram-positive organisms, while sulbactam inhibits beta-lactamase enzymes that would otherwise inactivate ceftriaxone 3. For severe infections, the dosage can be increased to every 8 hours, not exceeding 4 grams of ceftriaxone and 2 grams of sulbactam per day. Key considerations include:
- Dosage adjustments for patients with renal impairment, particularly when creatinine clearance falls below 30 mL/min, where the dose should be reduced by 50% or the dosing interval extended.
- Administration requires reconstitution with an appropriate diluent and should be infused over 30 minutes.
- Monitoring patients for hypersensitivity reactions, particularly those with penicillin allergies, and being aware of potential side effects including gastrointestinal disturbances and elevated liver enzymes. Given the provided evidence, the most relevant and recent study does not directly address the maximum dose of ceftriaxone-sulbactam, but the combination's efficacy and safety profile are supported by various studies, including those comparing different antibiotic regimens for treating infections 4, 5. However, the specific details on the maximum dose are not explicitly mentioned in the recent studies provided, thus relying on general medical knowledge and established guidelines for the use of ceftriaxone-sulbactam.