Ceftriaxone (Rocephin) Treatment Regimens for Various Infections
Ceftriaxone (Rocephin) dosing varies by infection type, with 1g IM or IV once daily being the standard adult dose for most serious infections, while specific conditions like gonorrhea may require different dosing strategies.
Adult Dosing Regimens
Uncomplicated Gonococcal Infections
- Recommended regimen: 1g IM in a single dose 1
- For gonococcal conjunctivitis: 1g IM in a single dose with saline lavage of the infected eye 2
Disseminated Gonococcal Infection (DGI)
- Initial therapy: 1g IM or IV every 24 hours 2
- Hospitalization recommended for initial therapy
- Continue for 24-48 hours after improvement begins
- Then switch to oral therapy to complete 7 days of treatment:
- Cefixime 400mg orally twice daily OR
- Ciprofloxacin 500mg orally twice daily 2
Gonococcal Meningitis and Endocarditis
- Recommended regimen: 1-2g IV every 12 hours 2
- Continue for 10-14 days for meningitis
- Continue for at least 4 weeks for endocarditis
Other Serious Infections
- Standard adult dose: 1-2g given once daily (or divided twice daily) 3
- Total daily dose should not exceed 4g
- Duration typically 4-14 days; longer for complicated infections
- For surgical prophylaxis: 1g IV 30-120 minutes before surgery 3
Pediatric Dosing Regimens
General Infections
- Skin/soft tissue infections: 50-75mg/kg once daily (not to exceed 2g) 3
- Serious infections (non-meningitis): 50-75mg/kg/day divided every 12 hours (not to exceed 2g) 3
- Meningitis: Initial dose 100mg/kg (not to exceed 4g), then 100mg/kg/day once daily or divided every 12 hours (not to exceed 4g) 3
Neonatal Gonococcal Infections
- Ophthalmia neonatorum: 25-50mg/kg IV or IM in a single dose (not to exceed 125mg) 2
- Disseminated infection: 25-50mg/kg/day IV or IM for 7 days (10-14 days if meningitis is documented) 2
Special Considerations
Administration
- Intramuscular: Inject well within a relatively large muscle
- Intravenous: Administer over 30 minutes (60 minutes in neonates)
- Compatibility: Do not use diluents containing calcium (e.g., Ringer's solution) 3
Precautions
- Pregnancy: Safe to use; preferred over quinolones and tetracyclines 2
- Allergies: For patients allergic to cephalosporins, alternatives include:
- Spectinomycin (for non-pharyngeal gonorrhea)
- Quinolones (contraindicated in pregnancy and children) 2
- Neonates: Use cautiously in hyperbilirubinemic infants, especially premature neonates 2
Co-infections
- When treating gonorrhea, add appropriate coverage for potential Chlamydia trachomatis co-infection 3
- For pelvic inflammatory disease, add antichlamydial coverage 3
Treatment Duration
- Uncomplicated gonorrhea: Single dose
- Disseminated gonococcal infection: 7 days total
- Meningitis: 10-14 days
- Endocarditis: At least 4 weeks
- Standard bacterial infections: Continue for at least 2 days after signs and symptoms have disappeared (usually 4-14 days) 3
- Streptococcal infections: Minimum 10 days 3
Monitoring
- No dosage adjustment necessary for patients with renal or hepatic impairment 3
- Monitor for potential side effects including leukopenia, rash, fever, and enterocolitis 4
- Platelet counts may increase (>500,000/mm³) during treatment 5
Ceftriaxone has proven to be highly effective for serious infections with once or twice daily dosing, making it convenient for both inpatient and outpatient treatment settings 6.