Ceftriaxone Dosing for Urinary Tract Infections
For treating urinary tract infections (UTIs), ceftriaxone should be administered at a dose of 1-2 grams IV or IM once daily, with the specific dose depending on infection severity and patient characteristics. 1
Adult Dosing Recommendations
- For uncomplicated UTIs requiring parenteral therapy, administer ceftriaxone 1 gram IV or IM once daily 1, 2
- For complicated UTIs or pyelonephritis, administer ceftriaxone 1-2 grams IV or IM once daily 1, 3
- When treating pyelonephritis in outpatients, a single initial dose of 1 gram ceftriaxone IV or IM is recommended before transitioning to oral therapy 4
- For hospitalized patients with pyelonephritis, continue ceftriaxone 1-2 grams IV once daily until clinical improvement, then consider transition to oral therapy 4, 1
- Duration of therapy typically ranges from 7-14 days depending on infection severity and clinical response 1, 3
Pediatric Dosing Recommendations
- For children with UTIs, administer ceftriaxone 50-75 mg/kg IV or IM once daily (maximum 2 grams) 1
- For infants 22-28 days old with UTI, administer ceftriaxone 50 mg/kg IV or IM once daily 4
- For infants 29-60 days old with UTI, administer ceftriaxone 50 mg/kg IV or IM once daily 4
- For infants 8-21 days old, ceftriaxone is not recommended as first-line therapy; ampicillin plus ceftazidime or gentamicin is preferred 4
Administration Guidelines
- Intravenous administration should occur over 30 minutes in adults 1
- For intramuscular administration, reconstitute with appropriate diluent and inject into a large muscle 1
- Do not use diluents containing calcium, such as Ringer's solution or Hartmann's solution, to reconstitute ceftriaxone 1
- Ceftriaxone must not be administered simultaneously with calcium-containing IV solutions 1
Clinical Considerations
- Ceftriaxone's once-daily dosing is a significant advantage compared to other antibiotics requiring multiple daily doses 2, 5
- Clinical studies have demonstrated high efficacy rates (86-91%) for ceftriaxone in complicated UTIs 5, 6
- In areas with high fluoroquinolone resistance (>10%), ceftriaxone is an appropriate initial parenteral therapy for pyelonephritis 4
- Ceftriaxone has demonstrated superior bacteriological cure rates compared to cefazolin in clinical trials for UTIs 2
- For patients transitioning from IV to oral therapy, ensure the oral agent is appropriate based on culture and susceptibility results 4, 3
Common Pitfalls to Avoid
- Avoid underdosing in complicated UTIs or pyelonephritis, as this may lead to treatment failure 4, 1
- Do not administer ceftriaxone to neonates with hyperbilirubinemia or those requiring calcium-containing solutions 1
- Remember to obtain urine cultures before initiating therapy, especially in complicated UTIs and pyelonephritis 4
- Be aware that ceftriaxone has no activity against Chlamydia trachomatis; appropriate coverage should be added if this pathogen is suspected 1
- Consider local resistance patterns when selecting empiric therapy, as this may influence treatment success 4