Recommended Ceftriaxone Dosing for Adults and Children
For adults, the recommended ceftriaxone dose is 1-2 grams per day, while for children, the recommended dose is 50-100 mg/kg/day, with specific dosing based on the type of infection being treated. 1, 2
Adult Dosing
Standard Dosing
- General infections: 1-2 grams once daily (or in equally divided doses twice daily)
- Maximum daily dose: 4 grams 2
Specific Conditions
- Skin/soft tissue infections: 1-2 grams once daily
- Uncomplicated gonorrhea: 250 mg single intramuscular dose
- Surgical prophylaxis: 1 gram IV 30-120 minutes before surgery
- Community-acquired pneumonia: 1 gram daily (equally effective as 2 grams daily with fewer side effects) 3
Pediatric Dosing
Standard Dosing
- General infections: 50-75 mg/kg/day given once daily or divided twice daily
- Maximum daily dose: 2 grams 2
Specific Conditions
- Meningitis: 100 mg/kg/day (not to exceed 4 grams daily), given once daily or divided twice daily 1, 2
- Skin/soft tissue infections: 50-75 mg/kg/day once daily (or divided twice daily) 2
- Acute otitis media: 50 mg/kg single intramuscular dose (not to exceed 1 gram) 2
Administration Considerations
Intravenous Administration
- Adults: Administer over 30 minutes
- Neonates: Administer over 60 minutes to reduce risk of bilirubin encephalopathy 2
Intramuscular Administration
- Reconstitute with appropriate diluent
- Inject well within the body of a relatively large muscle 2
Important Precautions
- Neonates: Contraindicated in premature neonates and those ≤28 days if they require calcium-containing IV solutions 2
- Calcium-containing solutions: Do not mix with or administer simultaneously with calcium-containing solutions due to risk of precipitation 2
- Duration of therapy: Generally 4-14 days; for complicated infections, longer therapy may be required 2
- For Streptococcus pyogenes infections: minimum 10 days 2
Special Populations
- Renal/hepatic impairment: No dosage adjustment necessary for patients with impaired renal or hepatic function, up to 2 grams per day 2
- Elderly patients: No modification required for doses up to 2 grams per day, provided there is no severe renal or hepatic impairment 2
Clinical Pearls
- Recent evidence suggests that for community-acquired pneumonia, 1 gram daily is as effective as 2 grams daily with lower rates of C. difficile infection and shorter hospital stays 3
- For bacterial meningitis in children, once-daily dosing (100 mg/kg/day) achieves target concentrations more rapidly than twice-daily dosing 4
- The long half-life of ceftriaxone (7.6-8.3 hours) allows for once-daily dosing in most cases, which is advantageous for outpatient parenteral therapy 5
- When treating infective endocarditis with ceftriaxone, the dose is 100 mg/kg/day IV divided every 12 hours or 80 mg/kg/day IV every 24 hours (maximum 4 grams daily) 1
Remember that appropriate dosing should be based on the specific infection being treated, the patient's age and weight, and local antimicrobial resistance patterns.