What is the recommended adult dose of ceftriaxone (Ceftriaxone) for typhoid fever?

Ceftriaxone Dosing for Typhoid Fever in Adults

The recommended adult dose of ceftriaxone for typhoid fever is 2-4 grams IV once daily for 5-7 days. 1

Dosing Details

For adults with typhoid fever, ceftriaxone should be administered according to the following guidelines:

• Standard dose: 2-4 grams IV daily 2
• Duration: 5-7 days 1
• Administration: Intravenous infusion over 30 minutes 2
• Maximum daily dose: Should not exceed 4 grams 2

For severe infections or complicated cases:

• Consider the higher end of the dosing range (4 grams daily)
• This can be divided into two doses of 2 grams every 12 hours 2

Evidence and Rationale

The World Health Organization (WHO) recommends ceftriaxone as a second-line agent for typhoid fever at a dose of 80 mg/kg daily for 5-7 days 1. For adults, this translates to approximately 2-4 grams daily, not exceeding the maximum daily dose of 4 grams.

Clinical trials have demonstrated the efficacy of ceftriaxone for typhoid fever using various dosing regimens:

• 75 mg/kg/day (approximately 3-4 grams for adults) for 5 days 3
• 2 grams daily for 3 days 4
• 3 grams daily for 3 days 5

These studies showed that ceftriaxone rapidly sterilizes blood cultures (typically within 3 days) and provides clinical cure rates comparable to traditional 14-day chloramphenicol regimens 3, 4.

Important Considerations

• Rapid bactericidal effect: Ceftriaxone typically renders blood cultures negative within 3 days of treatment initiation 3
• Prolonged fever: Despite bacteriological clearance, fever may persist for several days after starting treatment 6
• No dosage adjustment: No modification needed for patients with renal or hepatic impairment unless severe 2
• Administration precautions: Do not mix with calcium-containing solutions due to precipitation risk 2

Advantages of Ceftriaxone for Typhoid

1. Once-daily dosing (convenient administration)
2. Short treatment duration (5-7 days vs. 14 days for chloramphenicol)
3. Excellent tissue penetration
4. No bone marrow suppression (unlike chloramphenicol) 3
5. High efficacy against Salmonella typhi, including many resistant strains

Clinical Response Expectations

• Blood culture negativity typically occurs within 3 days of treatment
• Fever defervescence occurs in approximately 4 days in uncomplicated cases 7
• Clinical cure rates of approximately 80-90% can be expected 3, 4

Remember that despite the rapid bacteriological clearance with ceftriaxone, fever may persist longer than with some other antibiotics. This does not necessarily indicate treatment failure unless it continues beyond 7 days or clinical deterioration occurs.