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 by 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 medication should be reserved for more severe infections, treatment failures, or patients who cannot tolerate oral antibiotics, as less broad-spectrum oral options are typically preferred for uncomplicated cases to reduce antimicrobial resistance.
• For children, a single 50-mg/kg dose of ceftriaxone, given either intravenously or intramuscularly, can be used, and if clinical improvement is observed at 24 hours, an oral antibiotic can be substituted to complete the course of therapy, as recommended by the American Academy of Pediatrics 1 and supported by the American Family Physician guideline 1.

Administration and Monitoring

• For IM administration, the medication should be reconstituted with an appropriate diluent and can be given in a large muscle like the gluteus maximus.
• Patients should be monitored for side effects including diarrhea, allergic reactions, and pain at injection sites.

Evidence-Based Recommendation

• The 2013 guideline by the American Academy of Pediatrics 1 provides the most recent and highest quality evidence for the use of ceftriaxone in treating otitis media and sinusitis, and its recommendations should be followed in clinical practice.
• The American Family Physician guideline 1 also supports the use of ceftriaxone in certain cases, but the 2013 AAP guideline is more comprehensive and specific to the treatment of acute bacterial sinusitis in children.

From the FDA Drug Label

For the treatment of acute bacterial otitis media, a single intramuscular dose of 50 mg/kg (not to exceed 1 gram) is recommended 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.

Ceftriaxone can be used to treat otitis media (ear infection) and sinusitis is not explicitly mentioned in the provided drug labels, but skin and skin structure infections are mentioned.

• The dosing recommendations for otitis media are:
  • A single intramuscular dose of 50 mg/kg (not to exceed 1 gram) for pediatric patients.
• The dosing recommendations for skin and skin structure infections are:
  • 50 to 75 mg/kg given once a day (or in equally divided doses twice a day) for pediatric patients.
  • 1 to 2 grams given once a day (or in equally divided doses twice a day) for adults. 2 3

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 4, 5.
• 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 4, 5.
• 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% 6.

Dosing Recommendations

• Ceftriaxone can be administered intravenously or intramuscularly, with a recommended once-daily administration schedule due to its long half-life 4, 5.
• 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 5, 7.
• For skin and soft tissue infections, ceftriaxone can be given every 12 hours in children and every 24 hours in most adults 8.

Administration Routes

• Ceftriaxone can be administered via intravenous (IV) or intramuscular (IM) routes 4, 5.
• The choice of administration route may depend on the patient's condition, the severity of the infection, and the desired duration of treatment 5, 8.