Recommended Ceftriaxone Dosing for Pneumonia
For community-acquired pneumonia (CAP), the recommended dose of ceftriaxone is 1-2 g IV once daily, with 1 g daily being sufficient for most cases of moderate severity. 1
Dosing Guidelines Based on Severity and Setting
Outpatient/Non-severe CAP
- Ceftriaxone 1 g IV/IM once daily 1, 2
- Often combined with a macrolide (azithromycin 500 mg daily or clarithromycin 500 mg twice daily) 1
Hospitalized, Non-ICU Patients
Severe CAP/ICU Patients
- Ceftriaxone 2 g IV once daily recommended 1, 4
- Higher dose particularly beneficial in patients requiring mechanical ventilation (17.2% vs 20.4% mortality with 1 g dosing) 4
Special Considerations
Pathogen-Specific Dosing
- S. pneumoniae: 1 g daily is typically sufficient 2, 3
- MSSA infections: 2-4 g daily recommended (1 g daily associated with poor outcomes) 5
- Drug-resistant S. pneumoniae: Consider 2 g IV once daily 1
Patient Factors Affecting Dosing
- Renal function: No dosage adjustment needed for renal impairment
- Severe infections: Higher end of dosing range (2 g daily) recommended 1
- Pseudomonas risk: Ceftriaxone is not effective; alternative agents needed 1
Duration of Treatment
- Continue until patient has been afebrile for 48-72 hours
- Minimum 5 days for uncomplicated CAP
- 7-14 days for complicated pneumonia 1
Important Caveats
- Ceftriaxone alone is not effective against atypical pathogens (Mycoplasma, Chlamydia, Legionella) and should be combined with a macrolide or doxycycline 1
- For patients with contraindications to macrolides, ceftriaxone + doxycycline 100 mg twice daily is an acceptable alternative 1
- Meta-analysis shows 1 g daily dosing is as effective as 2 g daily for most CAP cases (OR 1.02,95% CI [0.91-1.14]) 2
- Higher doses (2 g daily) may be associated with slightly increased risk of adverse events, particularly C. difficile infection (1.9% vs 1.8%) 4
Bottom Line
For most cases of community-acquired pneumonia, ceftriaxone 1 g IV once daily (combined with appropriate coverage for atypical pathogens) is effective. Reserve 2 g daily dosing for severe pneumonia requiring ICU admission/mechanical ventilation, suspected MSSA infection, or areas with high pneumococcal resistance.