What is the recommended dose of Ceftriaxone for typhoid fever?

Recommended Ceftriaxone Dosage for Typhoid Fever

For typhoid fever, ceftriaxone should be administered at a dose of 80 mg/kg/day intravenously for 5-7 days in adults and children. 1

Dosing Guidelines by Age Group

Adults

• 80 mg/kg/day IV daily (up to 4 g/day) for 5-7 days 1
• Alternative regimen: 3-4 g IV daily in a single dose for 7 days 2

Children

• 80 mg/kg/day IV daily for 5-7 days 1
• For flexible-duration therapy: 75 mg/kg/day IV (maximum 2 g/day) in two divided doses until defervescence plus 5 additional days 3
• Alternative approach: 50-75 mg/kg/day IV given every 12-24 hours 1

Treatment Duration Considerations

• Standard duration: 5-7 days is generally sufficient for uncomplicated typhoid fever 1, 4
• Flexible-duration approach: Continue treatment until defervescence plus 5 additional days 3
• Extended therapy may be required for complicated cases or persistent fever 5

Clinical Evidence and Efficacy

• Ceftriaxone rapidly clears bacteremia, with negative blood cultures typically achieved by day 3 of treatment 4
• Clinical cure rates of 79-100% have been reported with ceftriaxone regimens 3, 4
• Single daily dosing is effective due to the prolonged half-life of ceftriaxone, with adequate minimum concentrations maintained throughout the 24-hour dosing interval 6

Important Considerations

• Fever may persist for several days despite appropriate antibiotic therapy and clearance of bacteremia 4
• Ceftriaxone should not be used in hyperbilirubinemic neonates 1
• For severe infections or complications (meningitis, endocarditis), higher doses or longer duration may be required 1
• Pharmacokinetics in typhoid patients may differ from healthy individuals, with potentially faster clearance, but adequate drug levels are still maintained with once-daily dosing 6

Alternative Antibiotics

• Second-line options for typhoid fever include:
  • Ciprofloxacin: 15 mg/kg orally twice daily for 7-10 days 1
  • Azithromycin: 20 mg/kg orally daily for 5-7 days 1

Common Pitfalls to Avoid

• Underdosing ceftriaxone may lead to treatment failure, especially in severe infections 6
• Prolonged fever despite appropriate therapy is common and should not necessarily prompt a change in antibiotics if clinical improvement is occurring 4
• Failure to monitor for potential adverse effects such as biliary sludging with prolonged high-dose therapy 1
• Not completing the full course of antibiotics even if symptoms resolve quickly 3