Ceftriaxone Dosing for Pediatric Patients
The recommended dosage of ceftriaxone for pediatric patients varies by indication, with standard dosing of 50-100 mg/kg/day for most infections, while meningitis requires 100 mg/kg/day (not exceeding 4 grams daily). 1
Dosing by Indication
Standard Infections
- Skin and skin structure infections: 50-75 mg/kg/day given once daily or divided twice daily (maximum: 2 grams/day) 1
- Serious miscellaneous infections (non-meningitis): 50-75 mg/kg/day divided every 12 hours (maximum: 2 grams/day) 1
- Pneumonia: 50-100 mg/kg/day every 12-24 hours 2, 3
- For penicillin-resistant S. pneumoniae: 100 mg/kg/day 3
Special Indications
- Meningitis: Initial dose of 100 mg/kg (maximum: 4 grams), followed by 100 mg/kg/day once daily or divided every 12 hours (maximum: 4 grams/day) 1
- Acute bacterial otitis media: Single intramuscular dose of 50 mg/kg (maximum: 1 gram) 1
Age-Specific Considerations
Neonates
- ≤7 days postnatal age: 50 mg/kg/day given every 24 hours 3
- >7 days postnatal age and >2000g: 50-75 mg/kg/day given every 24 hours 3
- Important: Administer IV doses over 60 minutes in neonates to reduce risk of bilirubin encephalopathy 1
Infants and Children
- Standard dosing applies as per indication
- For suspected penicillin-resistant S. pneumoniae in pneumonia: 100 mg/kg/day 3
Administration Routes and Methods
Intravenous Administration
- Administer over 30 minutes (except in neonates, where 60 minutes is recommended) 1
- Reconstitute with appropriate IV diluent to concentration between 10-40 mg/mL 1
Intramuscular Administration
- Reconstitute to 250-350 mg/mL concentration 1
- Inject well within the body of a relatively large muscle 1
Treatment Duration
- General infections: 4-14 days; continue at least 2 days after signs and symptoms have disappeared 1
- Meningitis: Typically 7-14 days 1
- Streptococcal infections: Minimum 10 days 1
Important Clinical Considerations
Dosing Frequency
- For most infections, once-daily dosing is effective due to ceftriaxone's long half-life 4
- For meningitis, recent evidence supports once-daily (100 mg/kg) over twice-daily (50 mg/kg) dosing for earlier achievement of pharmacodynamic targets 5
Special Populations
- Renal/Hepatic Impairment: No dosage adjustment necessary unless severe impairment 1
- Elderly: No modification required up to 2 grams per day 1
Compatibility and Safety
- Do not use diluents containing calcium (e.g., Ringer's solution, Hartmann's solution) due to risk of particulate formation 1
- Incompatible with: Vancomycin, amsacrine, aminoglycosides, and fluconazole in admixtures 1
Common Adverse Effects
- Diarrhea, superficial candidiasis, and transient laboratory abnormalities (elevated liver enzymes, thrombocytosis) may occur but rarely require discontinuation 6
Pharmacokinetic Considerations
- In critically ill children, standard dosing (100 mg/kg once daily) provides adequate exposure for most susceptible pathogens 7
- For patients with enhanced renal clearance (eGFR >80 mL/min/1.73m²) or when targeting less-susceptible pathogens (MIC ≥0.5 mg/L), consider 50 mg/kg twice daily for improved target attainment 7
The evidence strongly supports these dosing recommendations, which balance efficacy against common pathogens with safety considerations in the pediatric population.