From the Guidelines
Ceftriaxone dosing typically ranges from 1-2 grams once or twice daily for most adult infections, with the specific dose depending on infection severity and site, as recommended by recent guidelines 1. For standard infections like pneumonia or urinary tract infections, 1-2 grams once daily is usually sufficient. For more severe infections such as meningitis, 2 grams every 12 hours is recommended 1. Children generally receive 50-100 mg/kg/day divided into one or two doses, not exceeding the adult maximum. Treatment duration varies by infection type, typically 7-14 days for most infections, though longer courses may be needed for complicated cases. Ceftriaxone should be administered intravenously or intramuscularly, with IV administration preferred for severe infections. Dose adjustments are necessary for patients with severe renal and hepatic impairment when used together. Ceftriaxone is effective against many gram-positive and gram-negative bacteria as it binds to penicillin-binding proteins to inhibit bacterial cell wall synthesis. Monitor for side effects including hypersensitivity reactions, gastrointestinal disturbances, and potential biliary sludging with prolonged use. Some specific considerations for dosing include:
- For pneumococcal meningitis, 2 g ceftriaxone IV 12 hourly is recommended 1.
- For infections involving a prosthetic valve or other prosthetic material caused by viridans group streptococci and Streptococcus bovis, 2 g ceftriaxone IV/IM in 1 dose is recommended 1.
- For necrotizing infections of the skin, fascia, and muscle, 1 to 2 g ceftriaxone every 24 h IV may be used as part of the treatment regimen 1. It's essential to consult the most recent guidelines and consider the specific infection, patient population, and local resistance patterns when determining the optimal dosing regimen for ceftriaxone 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Ceftriaxone for injection may be administered intravenously or intramuscularly. Pediatric patients For the treatment of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses twice a day). The usual adult daily dose is 1 to 2 grams given once a day (or in equally divided doses twice a day) depending on the type and severity of infection.
The recommended dosing for ceftriaxone is as follows:
- Pediatric patients: 50 to 75 mg/kg per day for skin and skin structure infections, not to exceed 2 grams per day.
- Adults: 1 to 2 grams per day, depending on the type and severity of infection, not to exceed 4 grams per day. 2
From the Research
Dosing Ceftriaxone
The recommended dosing for ceftriaxone varies depending on the type of infection and the patient's age.
- For non-central nervous system (CNS) infections, a dose of 50 mg/kg is recommended 3.
- For CNS infections, an initial dose of 100 mg/kg followed by 80 mg/kg 12 hours later and once daily thereafter is recommended 3.
- In children, a single daily dose of 50 to 100 mg/kg intravenously or intramuscularly is effective for serious bacterial infections, including meningitis 4.
- In adults, a single 1-g dose daily is sufficient to exceed the minimal inhibitory concentrations (MICs) of most staphylococcal and streptococcal species and Enterobacteriaceae for 12 to 24 hours 5.
- A 12-hourly regimen of 1 g intravenously is also effective in the treatment of serious bacterial infections 6.
Administration Route
Ceftriaxone can be administered intravenously or intramuscularly, with similar plasma concentrations achieved by both routes 3, 5.
- Intravenous infusion and intramuscular injection have similar plasma half-lives, ranging from 7.6 to 8.3 hours 5.
- Plasma concentrations exceed the MICs of most aerobic gram-positive and gram-negative organisms for 24 hours after a 1-g dose 5.
Special Considerations
- In neonates and infants, ceftriaxone may cause sterilization of the gut with overgrowth of Candida albicans 4.
- Prolonged fever may occur in 13% of all patients treated with ceftriaxone 4.
- Ceftriaxone is generally recognized as safe and effective for skin and soft tissue infections, particularly those caused by staphylococci and streptococci 7.