Rocephin (Ceftriaxone) Injection Dosing Guidelines
The recommended dosing for Rocephin (ceftriaxone) injection varies by age, weight, and type of infection, with adult dosing typically ranging from 1-2 grams once daily for most infections, not exceeding 4 grams per day. 1
Adult Dosing (≥45 kg)
- Standard dosing: 1-2 grams IV/IM once daily or divided twice daily
- Maximum daily dose: 4 grams 1
- Duration: Generally 4-14 days; complicated infections may require longer therapy 1
Specific Adult Indications:
- Uncomplicated infections: 1-2 grams IV/IM daily 2
- Severe infections: 2 grams IV every 12 hours (4 grams total daily) 2
- Uncomplicated gonorrhea: 250 mg IM single dose 1
- Surgical prophylaxis: 1 gram IV 30-120 minutes before surgery 1
Pediatric Dosing
Neonates:
- ≤7 days old: 50 mg/kg/day given every 24 hours 3
- >7 days old and ≤2000g: 50 mg/kg/day given every 24 hours 3
- >7 days old and >2000g: 50-75 mg/kg/day given every 24 hours 3
- Important: Administer over 60 minutes in neonates to reduce risk of bilirubin encephalopathy 1
- Caution: Should not be used in hyperbilirubinemic neonates 3
Infants and Children:
- Skin/soft tissue infections: 50-75 mg/kg/day once daily (maximum: 2 grams) 1
- Acute otitis media: 50 mg/kg IM single dose (maximum: 1 gram) 1
- General infections: 50-75 mg/kg/day in divided doses every 12-24 hours (maximum: 2 grams) 3, 1
- Meningitis: 100 mg/kg/day once daily or divided every 12 hours (maximum: 4 grams) 1
Weight-Based Considerations:
- Children <45 kg with uncomplicated gonorrhea: 125 mg IM single dose 3
- Children <45 kg with bacteremia/arthritis: 50 mg/kg/day (maximum: 1 gram) for 7 days 3
- Children >45 kg: Use adult dosing regimens 3
Special Populations
- Renal/hepatic impairment: No dosage adjustment necessary unless severe impairment 1
- Elderly patients: No modification needed up to 2 grams per day, unless severe renal/hepatic impairment 1
Administration Guidelines
- IV administration: Infuse over 30 minutes (adults) 2
- IV concentration: 10-40 mg/mL recommended 1
- IM administration: Inject well within a large muscle; reconstitute to 250-350 mg/mL 1
- Compatibility warning: Do not use diluents containing calcium (e.g., Ringer's solution) 1
Important Considerations
- For streptococcal infections, continue therapy for at least 10 days 1
- When treating suspected Chlamydia trachomatis, add appropriate antichlamydial coverage 1
- For febrile infants 29-60 days old with no identified focus of infection, ceftriaxone 50 mg/kg IV/IM every 24 hours is recommended 3
- Avoid concurrent administration with calcium-containing IV solutions due to precipitation risk 2
Ceftriaxone's long half-life allows for once or twice daily dosing, making it convenient for both inpatient and outpatient settings while maintaining excellent tissue penetration at concentrations above the MIC for most pathogens for more than 24 hours 4.