What is the dosage and administration of ceftriaxone for treating bacterial infections?

Ceftriaxone Dosage and Administration for Bacterial Infections

For treating bacterial infections, ceftriaxone should be administered at 1-2 grams intravenously or intramuscularly every 24 hours for most adult infections, with specific dosing based on infection type and severity. 1

Standard Adult Dosing

• For most uncomplicated infections, the standard adult daily dose is 1-2 grams given once daily (or divided twice daily) depending on the type and severity of infection 2
• The total daily dose should not exceed 4 grams in adults 2
• Ceftriaxone may be administered intravenously or intramuscularly 2
• Intravenous administration should be given over a period of 30 minutes 2

Dosing by Specific Infection Type

Uncomplicated Gonococcal Infections

• For uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended 2, 3
• When treating gonorrhea, medications should be dispensed on site to maximize compliance 3
• Ceftriaxone 125 mg IM in a single dose has been shown to cure 98.9% of uncomplicated urogenital and anorectal gonococcal infections 3

Disseminated Gonococcal Infection (DGI)

• For DGI, initial treatment with ceftriaxone 1 gram IM or IV every 24 hours is recommended 1
• Continue for 24-48 hours after improvement begins, then switch to oral therapy to complete a full week of treatment 1

Meningitis

• For bacterial meningitis, ceftriaxone 2 grams IV every 12 hours (total 4g daily) for 10-14 days is recommended 1
• In children with meningitis, the initial therapeutic dose should be 100 mg/kg (not to exceed 4 grams), followed by a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) 2

Endocarditis

• For gonococcal endocarditis, ceftriaxone 1-2 grams IV every 12 hours for at least 4 weeks is recommended 1

Pediatric Dosing

• For skin and skin structure infections in children, the recommended total daily dose is 50-75 mg/kg given once daily (or in equally divided doses twice daily) 2
• The total daily dose should not exceed 2 grams for most pediatric infections 2
• For acute bacterial otitis media, a single intramuscular dose of 50 mg/kg (not to exceed 1 gram) is recommended 2
• For serious infections other than meningitis, the recommended total daily dose is 50-75 mg/kg, given in divided doses every 12 hours 2

Special Populations and Considerations

• No dosage adjustment is necessary for patients with impairment of renal or hepatic function 2
• 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
• For neonates, intravenous doses should be given over 60 minutes to reduce the risk of bilirubin encephalopathy 2
• Ceftriaxone is contraindicated in premature neonates and in neonates (≤28 days) if they require treatment with calcium-containing IV solutions 2

Administration Guidelines

Intramuscular Administration

• Reconstitute ceftriaxone powder with the appropriate diluent 2
• After reconstitution, each 1 mL of solution contains approximately 250 mg or 350 mg of ceftriaxone depending on the amount of diluent used 2
• Inject well within the body of a relatively large muscle; aspiration helps avoid unintentional injection into a blood vessel 2

Intravenous Administration

• Concentrations between 10 mg/mL and 40 mg/mL are recommended for IV administration 2
• Do not use diluents containing calcium, such as Ringer's solution or Hartmann's solution, to reconstitute ceftriaxone 2
• After reconstitution for IV use, each 1 mL of solution contains approximately 100 mg of ceftriaxone 2

Duration of Therapy

• Generally, ceftriaxone therapy should be continued for at least 2 days after the signs and symptoms of infection have disappeared 2
• The usual duration of therapy is 4-14 days; in complicated infections, longer therapy may be required 2
• When treating infections caused by Streptococcus pyogenes, therapy should be continued for at least 10 days 2

Important Precautions

• Do not use diluents containing calcium with ceftriaxone due to risk of precipitation 2
• If treating gonorrhea, consider adding treatment for chlamydia if chlamydial infection is not ruled out 3
• For pharyngeal gonococcal infections, higher doses may be more effective due to the complex pharmacokinetics of ceftriaxone in pharyngeal tissue 3