What is the recommended dosing of Ceftriaxone (a cephalosporin antibiotic) for the treatment of pneumonia?

Ceftriaxone Dosing for Pneumonia

For adult patients with pneumonia, ceftriaxone should be administered at a dose of 1-2 g intravenously every 24 hours, with 1 g daily being as effective as 2 g daily for most community-acquired pneumonia cases. 1

Adult Dosing Recommendations

Community-Acquired Pneumonia (CAP)

• Standard dose: 1 g IV once daily 1

  • This dosage is as effective as higher doses for most cases of CAP
  • Duration: 5-7 days (minimum 5 days, ensuring patient is afebrile for 48-72 hours)

• Severe CAP or suspected resistant pathogens: 2 g IV once daily 2

  • Consider this higher dose for:
    • ICU admission
    • Suspected drug-resistant pneumococcal infection
    • Recent travel to areas with high antimicrobial resistance

Hospital-Acquired Pneumonia (HAP)

• Standard dose: 2 g IV once daily 2
• Duration: 7-14 days depending on clinical response

Special Population Considerations

Elderly Patients (≥60 years)

• For suspected meningitis with pneumonia: 2 g IV every 12 hours 2
• For pneumonia without meningitis: 1-2 g IV once daily 3

Pediatric Patients

• Standard dose: 50-100 mg/kg/day IV every 12-24 hours 2
• Maximum daily dose: 2 g
• For beta-lactamase producing organisms: higher end of dosing range

Clinical Decision Points

Factors favoring 2 g daily dosing:

• Severe illness (sepsis, respiratory failure)
• Immunocompromised status
• Suspected resistant pathogens
• Complicated pneumonia (empyema, lung abscess)

Factors allowing 1 g daily dosing:

• Mild to moderate CAP
• Immunocompetent host
• Low local resistance rates
• Uncomplicated pneumonia

Treatment Duration

• Continue until patient has been afebrile for 48-72 hours
• Minimum 5 days for uncomplicated CAP
• 7-14 days for complicated pneumonia or HAP
• Consider longer duration (10-14 days) for:
  • Slow clinical response
  • Bacteremia
  • Necrotizing pneumonia
  • Empyema

Monitoring and Follow-up

• Assess clinical response within 48-72 hours
• If no improvement after 48-72 hours:
  • Reassess diagnosis
  • Consider resistant pathogens
  • Evaluate for complications (empyema, abscess)
  • Consider broadening antibiotic coverage

Important Caveats

• Ceftriaxone monotherapy does not cover atypical pathogens (Mycoplasma, Legionella, Chlamydia) - consider adding a macrolide or doxycycline for empiric CAP treatment
• For penicillin-resistant pneumococci, ceftriaxone remains effective at standard doses
• Adjust dosing in severe renal impairment (CrCl <30 mL/min): maximum 2 g daily
• Recent evidence suggests 1 g daily is as effective as 2 g daily for most CAP cases, potentially reducing costs and side effects 1