Pediatric Dosing of Ceftriaxone
The recommended pediatric dose of ceftriaxone is 50-100 mg/kg/day given once daily or divided every 12-24 hours, with a maximum daily dose of 4 grams. 1, 2, 3
Age-Specific Dosing Recommendations
Neonates
- For neonates with postnatal age ≤7 days: 50 mg/kg/day given every 24 hours 1
- For neonates with postnatal age >7 days and ≤2000 g: 50 mg/kg/day given every 24 hours 1
- For neonates with postnatal age >7 days and >2000 g: 50-75 mg/kg/day given every 24 hours 1
- Should not be used in hyperbilirubinemic neonates 1
Infants and Children
- For bacterial meningitis: 100 mg/kg/day divided every 12-24 hours (maximum 4 g daily) 1
- For severe infections including pneumonia: 50-100 mg/kg/day given once daily or divided every 12-24 hours 1
- For less severe infections: 50-75 mg/kg/day given once daily or divided every 12-24 hours 1
Indication-Specific Dosing
Meningitis
- For bacterial meningitis: 100 mg/kg/day divided every 12-24 hours (maximum 4 g daily) 1, 4, 5
- Recent evidence suggests that once-daily dosing (100 mg/kg) may achieve earlier target attainment in CSF compared to twice-daily dosing 5
Pneumonia
- For community-acquired pneumonia: 50-100 mg/kg/day given once daily or divided every 12-24 hours 1
- For pneumococcal pneumonia with penicillin resistance (MICs ≥4.0 μg/mL): 100 mg/kg/day given every 12-24 hours 1
Intra-abdominal Infections
- For complicated intra-abdominal infections: 50-75 mg/kg/day given every 12-24 hours 1
Other Serious Infections
- For sepsis: 50-75 mg/kg/day given every 12-24 hours 1, 6
- For osteomyelitis/septic arthritis: 50-100 mg/kg/day given once daily 6
Administration Considerations
- Intravenous doses should be infused over 30 minutes 2, 3
- Intramuscular administration is completely absorbed with peak concentrations occurring between 2-3 hours post-dose 2, 3
- Once-daily administration (50-80 mg/kg) has been shown to be effective for many serious bacterial infections in children, with a clinical cure rate of 94% 6
Pharmacokinetic Considerations
- In pediatric patients with meningitis, ceftriaxone penetrates inflamed meninges with CSF concentrations of 5.6-6.4 μg/mL after IV doses of 50-75 mg/kg 2, 3, 4
- The elimination half-life in pediatric patients ranges from 4.3-4.6 hours 2, 3
- For patients with augmented renal clearance (eGFR >80 mL/min/1.73m²), twice-daily dosing of 50 mg/kg may improve target attainment 7
Important Precautions
- Ceftriaxone should not be administered simultaneously with calcium-containing IV solutions, including continuous calcium-containing infusions 2, 3
- Dosage adjustment is generally not required in patients with renal or hepatic impairment for doses up to 2 g per day 2, 3
- For critically ill children, the standard 100 mg/kg once-daily dose provides adequate exposure for most susceptible pathogens 7
Monitoring
- Clinical response should be monitored within 24-48 hours of initiating therapy 8
- For prolonged therapy, periodic monitoring of complete blood count, liver and renal function tests is recommended 2, 3
By following these dosing recommendations, ceftriaxone can be effectively and safely used in pediatric patients for a variety of serious bacterial infections.