Ceftriaxone Dosing Recommendations
For treating infections, ceftriaxone should be dosed at 1-2 grams intravenously or intramuscularly every 24 hours for most adult infections, with specific dosing based on infection type and severity. 1, 2
Adult Dosing Guidelines
General Infections
- Standard adult daily dose: 1-2 grams given once daily (or divided twice daily) depending on infection type and severity 1, 2
- Maximum daily dose should not exceed 4 grams 2
- Duration of therapy typically 4-14 days; complicated infections may require longer treatment 1
Specific Infection Types
Disseminated Gonococcal Infection (DGI)
- Initial treatment: Ceftriaxone 1 gram IM or IV every 24 hours 1
- Continue for 24-48 hours after improvement begins, then switch to oral therapy to complete a full week of treatment 1
- Hospitalization recommended for initial therapy, especially for patients who may not comply with treatment or have complications 1
Gonococcal Meningitis and Endocarditis
- Ceftriaxone 1-2 grams IV every 12 hours 1
- Meningitis treatment: continue for 10-14 days 1
- Endocarditis treatment: continue for at least 4 weeks 1
- Treatment of complicated DGI should involve specialist consultation 1
Uncomplicated Gonococcal Infections
- Single intramuscular dose of 250 mg is recommended 2
- For pharyngeal infections, higher doses may be needed due to pharmacokinetic variability in pharyngeal tissues 1
Surgical Prophylaxis
- Single dose of 1 gram administered intravenously 1/2 to 2 hours before surgery 2
Pediatric Dosing Guidelines
General Infections
- Skin and skin structure infections: 50-75 mg/kg once daily (or divided twice daily) 2
- Maximum daily dose should not exceed 2 grams 2
- Serious infections (excluding meningitis): 50-75 mg/kg daily in divided doses every 12 hours, not to exceed 2 grams daily 2
Meningitis
- Initial dose: 100 mg/kg (not to exceed 4 grams) 2
- Maintenance: 100 mg/kg/day (not to exceed 4 grams daily), administered once daily or divided every 12 hours 2
- Duration: Usually 7-14 days 2
Acute Otitis Media
- Single intramuscular dose of 50 mg/kg (not to exceed 1 gram) 2
Special Considerations
Resistant Infections
- For ceftriaxone-resistant strains, higher doses may be required 1
- Studies suggest that twice-daily dosing of 2 grams ceftriaxone may be needed for resistant strains 1
- Higher doses (up to 3 grams per dose) with repeat dosing have been used in China without reported treatment failures 1
Administration Considerations
- Intravenous doses should be administered over 30 minutes in adults 2
- In neonates, administer over 60 minutes to reduce risk of bilirubin encephalopathy 2
- Do not use diluents containing calcium (e.g., Ringer's solution or Hartmann's solution) due to risk of precipitation 2
Contraindications
- Contraindicated in hyperbilirubinemic neonates, especially premature infants 2
- Contraindicated in neonates (≤28 days) requiring calcium-containing IV solutions 2
Pharmacokinetics
- Mean peak plasma concentrations: 168 μg/ml for 1g IV, 81 μg/ml for 1g IM 3
- Plasma half-life: approximately 7-8 hours 3, 4
- Urinary recovery within 24 hours: 33-40% 3, 4
Treatment Failures and Resistance Considerations
- Treatment failures have been reported with ceftriaxone doses between 250-500 mg, particularly for pharyngeal infections 1
- For pharyngeal infections with elevated MICs, higher doses of ceftriaxone are particularly important 1
- Free plasma ceftriaxone concentration of 2-3 mg/L after 24 hours may be needed for efficient killing of resistant strains 1