Pediatric Dosage of Ceftriaxone
The recommended dosage of ceftriaxone for pediatric patients is 50-75 mg/kg/day given once daily (or in equally divided doses twice a day), with a maximum daily dose of 2 grams for most infections, and 100 mg/kg/day (maximum 4 grams) for meningitis. 1
General Dosing Guidelines
Standard Infections
- Mild to moderate infections: 50-75 mg/kg/day given once daily or divided twice daily 1
- Maximum daily dose: 2 grams
- Duration: Generally 4-14 days, depending on infection type and severity
Specific Conditions
Meningitis: 100 mg/kg/day (not to exceed 4 grams daily) 1
- Initial dose: 100 mg/kg (not to exceed 4 grams)
- Maintenance: 100 mg/kg/day given once daily or divided every 12 hours
- Duration: 7-14 days
Skin and soft tissue infections: 50-75 mg/kg/day once daily (or divided twice daily) 1
- Maximum daily dose: 2 grams
Acute bacterial otitis media: Single intramuscular dose of 50 mg/kg (not to exceed 1 gram) 1
Administration Guidelines
Intravenous Administration
- Administer over 30 minutes for most pediatric patients 1
- Important: For neonates, administer over 60 minutes to reduce risk of bilirubin encephalopathy 1
- Recommended concentrations: 10-40 mg/mL 1
Intramuscular Administration
- Inject well within the body of a relatively large muscle 1
- After reconstitution, concentration is approximately 250-350 mg/mL 1
Special Populations
Neonates
- Postnatal age ≤7 days: 50 mg/kg/day given every 24 hours 2
- Postnatal age >7 days and ≤2000 g: 50 mg/kg/day given every 24 hours 2
- Postnatal age >7 days and >2000 g: 50-75 mg/kg/day given every 24 hours 2
- Caution: Should not be used in hyperbilirubinemic neonates 2
Renal/Hepatic Impairment
- No dosage adjustment necessary for patients with impairment of renal or hepatic function unless severe 1
Clinical Efficacy and Considerations
- Once-daily dosing of ceftriaxone (50-80 mg/kg) has demonstrated a 94% clinical cure rate in serious pediatric infections 3
- For critically ill children, the standard 100 mg/kg once-daily dose provides adequate exposure for most susceptible pathogens 4
- In areas with high prevalence of less-susceptible pathogens (MIC ≥0.5 mg/L), a twice-daily dosing regimen of 50 mg/kg may improve target attainment 4
Important Precautions
- Do not use diluents containing calcium (e.g., Ringer's solution or Hartmann's solution) to reconstitute ceftriaxone 1
- Vancomycin, amsacrine, aminoglycosides, and fluconazole are incompatible with ceftriaxone in admixtures 1
- Monitor for adverse effects, particularly hematologic abnormalities like neutropenia 5
- Treatment should generally continue for at least 2 days after signs and symptoms of infection have disappeared 1
Duration of Therapy
- Standard infections: 4-14 days 1
- Streptococcal infections: Minimum 10 days 1
- Complicated infections may require longer therapy 1
The evidence strongly supports that once-daily administration of ceftriaxone is effective for most pediatric infections, offering the advantage of convenient dosing while maintaining excellent clinical efficacy.