Ceftriaxone Dosing for Typhoid Fever in Adults
For adults with typhoid fever, ceftriaxone should be administered at a dose of 2 grams intravenously once daily for 7-14 days.
Dosing Recommendations
The optimal dosing regimen for ceftriaxone in adult typhoid fever is based on several clinical studies and drug information:
- Dose: 2 grams
- Frequency: Once daily
- Route: Intravenous (IV)
- Duration: 7-14 days
Alternative Dosing Options
For severe infections or complicated typhoid fever:
- 2 grams IV every 12 hours (4 grams total daily) may be considered 1
Evidence Supporting This Recommendation
The FDA drug label for ceftriaxone states that for serious infections in adults, the usual daily dose is 1-2 grams given once daily (or in equally divided doses twice a day) depending on the type and severity of infection, with a maximum daily dose not exceeding 4 grams 1.
Clinical studies have demonstrated efficacy with various ceftriaxone regimens for typhoid fever:
- A randomized clinical trial showed that ceftriaxone 4 grams daily for 5 days was effective in treating typhoid fever 2
- Another study demonstrated efficacy with 3 grams daily for 3 days 3
- A study in patients with bacteremic typhoid fever found that 5-8 days of ceftriaxone therapy (50-60 mg/kg per day in two divided doses) was adequate for cure 4
Administration Guidelines
- IV infusion should be administered over 30 minutes 5
- For doses exceeding 2 grams daily, divide into twice-daily dosing (every 12 hours) 5
- Reconstitute with appropriate IV diluent; each 1 mL of solution should contain approximately 100 mg of ceftriaxone 1
Important Considerations
- Maximum daily dose: Should not exceed 4 grams 5, 1
- Monitoring: Assess clinical response within 48-72 hours of initiating therapy 5
- Precautions: Avoid concurrent administration with calcium-containing IV solutions due to precipitation risk 1
Outpatient Parenteral Antibiotic Therapy (OPAT)
For patients who have clinically improved and are candidates for outpatient therapy:
- Patient should be afebrile and clinically improving
- Patient should have received at least 5 days of inpatient therapy and monitoring
- Reliable IV access must be established
- Patient must have access to medical advice/care from the OPAT team 24 hours a day
- Recommended outpatient dose: 2 grams twice daily IV or 4 grams once daily IV 5
Shorter Course Options
Some evidence supports shorter treatment courses in selected patients:
- A 5-day course of ceftriaxone has been shown to be an effective alternative to conventional 14-day chloramphenicol therapy 2
- A 3-day course of ceftriaxone (2 g/day in adults) achieved clinical cure in 83% of patients in one study 3
However, for most patients with typhoid fever, a 7-14 day course is recommended to ensure complete eradication of the infection and prevent relapse.