Recommended Ceftriaxone Dosing for Treating Infections
The standard adult dose of ceftriaxone for most infections is 1-2 grams intravenously or intramuscularly once daily, with specific dosing based on infection type and severity. 1
Adult Dosing
- The usual adult daily dose is 1-2 grams given once daily (or in equally divided doses twice daily) depending on the type and severity of infection, with a maximum daily dose of 4 grams 2, 3
- For uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended 2, 3
- For surgical prophylaxis, a single dose of 1 gram administered intravenously 1/2 to 2 hours before surgery is recommended 2, 3
- For disseminated gonococcal infection, initial treatment is ceftriaxone 1 gram IM or IV every 24 hours until 24-48 hours after improvement begins 1
- For gonococcal meningitis and endocarditis, higher doses of 1-2 grams IV every 12 hours are recommended, with treatment duration of 10-14 days for meningitis and at least 4 weeks for endocarditis 1
Pediatric Dosing
- For skin and skin structure infections: 50-75 mg/kg/day given once daily or in equally divided doses twice daily, not to exceed 2 grams total daily dose 2, 3
- For acute bacterial otitis media: a single intramuscular dose of 50 mg/kg (not to exceed 1 gram) 2, 3
- For serious infections other than meningitis: 50-75 mg/kg/day in divided doses every 12 hours, not to exceed 2 grams total daily dose 2, 3
- For meningitis: initial dose of 100 mg/kg (not to exceed 4 grams), followed by 100 mg/kg/day (not to exceed 4 grams daily) given once daily or in equally divided doses every 12 hours 2, 3
- For neonatal gonococcal infections: 25-50 mg/kg/day IV or IM in a single daily dose for 7 days (10-14 days if meningitis is documented) 4
Special Populations
- No dosage adjustment is necessary for patients with impairment of renal or hepatic function 2, 3
- The dosages recommended for adults require no modification in elderly patients up to 2 grams per day, provided there is no severe renal and hepatic impairment 2, 3
- Ceftriaxone is contraindicated in hyperbilirubinemic neonates, especially premature infants 2, 3
- Ceftriaxone is contraindicated in neonates (≤28 days) if they require treatment with calcium-containing IV solutions 2, 3
Administration Considerations
- Intravenous administration should be over a period of 30 minutes (60 minutes in neonates to reduce the risk of bilirubin encephalopathy) 2, 3
- Do not use diluents containing calcium, such as Ringer's solution or Hartmann's solution, to reconstitute ceftriaxone 2, 3
- For intramuscular administration, inject well within the body of a relatively large muscle 2, 3
- Generally, ceftriaxone therapy should be continued for at least 2 days after the signs and symptoms of infection have disappeared 2, 3
- The usual duration of therapy is 4-14 days; in complicated infections, longer therapy may be required 2, 3
- When treating Streptococcus pyogenes infections, therapy should be continued for at least 10 days 2, 3
Treatment Efficacy Considerations
- Ceftriaxone has demonstrated high efficacy rates (>95%) in clinical studies for various infections 5, 6
- For ceftriaxone-resistant strains, higher doses with twice-daily administration of 2 grams may be required 1
- Treatment failures have been reported with lower doses (250-500 mg), particularly for pharyngeal infections 1