Can Ceftriaxone (a third-generation cephalosporin antibiotic) be used to treat otitis media (ear infection) or sinusitis (sinus infection), and what are the dosing recommendations for both intravenous (IV) and intramuscular (IM) administration?

From the Guidelines

Ceftriaxone can be used to treat otitis media and sinusitis, particularly in severe cases or when first-line treatments have failed, with a recommended dose of 50 mg/kg once for children who are vomiting, unable to tolerate oral medication, or unlikely to be adherent to the initial doses of antibiotic, as stated in the 2013 guideline from the American Academy of Pediatrics 1.

Key Points

• Ceftriaxone is a third-generation cephalosporin with excellent coverage against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
• The 2013 guideline from the American Academy of Pediatrics recommends ceftriaxone as an option for children with acute bacterial sinusitis who are vomiting, unable to tolerate oral medication, or unlikely to be adherent to the initial doses of antibiotic 1.
• The recommended dose of ceftriaxone for children is 50 mg/kg once, which can be given intravenously or intramuscularly.
• For adults, the typical IV/IM dose is 1-2 grams once daily for 5-7 days, as seen in other guidelines 1.

Administration

• For IM administration, the drug should be reconstituted with an appropriate diluent and injected deeply into a large muscle mass like the gluteus maximus.
• For IV administration, it should be infused over 30 minutes.

Considerations

• Ceftriaxone is generally reserved for more severe infections, treatment failures, or patients who cannot tolerate oral antibiotics, as less broad-spectrum oral antibiotics are typically preferred as first-line therapy for uncomplicated cases to minimize antimicrobial resistance.
• The 2014 guideline from the American Academy of Pediatrics also recommends ceftriaxone as an option for children with acute bacterial sinusitis who are vomiting, unable to tolerate oral medication, or unlikely to be adherent to the initial doses of antibiotic 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Ceftriaxone for injection may be administered intravenously or intramuscularly. For the treatment of acute bacterial otitis media, a single intramuscular dose of 50 mg/kg (not to exceed 1 gram) is recommended 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.

Ceftriaxone can be used to treat otitis media (ear infection) with a recommended dose of:

• Pediatric patients: a single intramuscular dose of 50 mg/kg (not to exceed 1 gram)
• Adults: the usual adult daily dose is 1 to 2 grams given once a day (or in equally divided doses twice a day) However, the provided drug label does not explicitly mention the use of Ceftriaxone for the treatment of sinusitis (sinus infection). The dosing recommendations for both intravenous (IV) and intramuscular (IM) administration are provided, but the specific dosing for sinusitis is not mentioned 2.

From the Research

Ceftriaxone Use in Otitis Media and Sinusitis

• Ceftriaxone, a third-generation cephalosporin antibiotic, has been shown to be effective in treating various infections, including those caused by Gram-negative and Gram-positive bacteria 3, 4.
• While there is limited direct evidence on the use of ceftriaxone for otitis media (ear infection) and sinusitis (sinus infection), studies suggest that it may be effective in treating these conditions due to its broad spectrum of activity 3, 4.
• A study comparing cefixime (a third-generation cephalosporin) and amoxicillin for the treatment of sinusitis found that once-a-day cefixime was effective in treating the infection, with a cure rate of 94% 5.

Dosing Recommendations

• Ceftriaxone can be administered intravenously or intramuscularly, with a recommended once-daily administration schedule due to its long half-life 3, 4.
• The dosage of ceftriaxone may vary depending on the type and severity of the infection, as well as the patient's age and renal function 4, 6.
• For skin and soft tissue infections, ceftriaxone can be given every 12 hours in children and every 24 hours in most adults 7.

Administration Routes

• Ceftriaxone can be administered via intravenous (IV) or intramuscular (IM) routes 3, 4.
• The choice of administration route may depend on the patient's condition, the severity of the infection, and the desired duration of treatment 4, 7.