What is the dosage and treatment duration of Rocephin (ceftriaxone) for cellulitis?

Rocephin (Ceftriaxone) Dosage and Treatment Duration for Cellulitis

For cellulitis, Rocephin (ceftriaxone) should be administered at 1-2 grams IV or IM once daily for 5 days, with extension if clinical improvement has not occurred within this time period. 1, 2

Dosing Recommendations

• For adults with cellulitis, the recommended dosage is 1-2 grams of ceftriaxone given once daily, depending on the severity of infection 2
• For pediatric patients with skin and skin structure infections, the recommended total daily dose is 50-75 mg/kg given once daily (or in equally divided doses twice a day), not to exceed 2 grams per day 2
• Ceftriaxone can be administered either intravenously or intramuscularly 2
• For intravenous administration, infuse over 30 minutes (60 minutes in neonates) 2

Treatment Duration

• The Infectious Diseases Society of America (IDSA) recommends a 5-day course of antimicrobial therapy for cellulitis 1
• Treatment should be extended if the infection has not improved within the initial 5-day period 1
• Generally, ceftriaxone therapy should be continued for at least 2 days after signs and symptoms of infection have disappeared 2
• The usual duration of therapy for skin infections is 4-14 days; in complicated infections, longer therapy may be required 2

Clinical Evidence

• Multiple studies have demonstrated the efficacy of once-daily ceftriaxone for skin and soft tissue infections 3, 4
• A randomized trial showed that 1 gram of ceftriaxone daily achieved clinical cure in 81% of patients with skin and soft tissue infections 3
• Ceftriaxone was particularly effective in polymicrobial infections, with no failures observed among patients with infections caused by multiple organisms 3

Special Considerations

• For cellulitis associated with penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or systemic inflammatory response syndrome (SIRS), consider adding coverage against MRSA 1
• In severely compromised patients, broader antimicrobial coverage may be warranted 1
• Elevation of the affected area and treatment of predisposing factors (such as edema or underlying cutaneous disorders) are important adjuncts to antibiotic therapy 1
• For patients with recurrent cellulitis, addressing predisposing factors such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities is crucial 1

Outpatient vs. Inpatient Treatment

• Outpatient therapy is recommended for patients who do not have systemic inflammatory response syndrome (SIRS), altered mental status, or hemodynamic instability 1
• Hospitalization should be considered if there is concern for deeper or necrotizing infection, poor adherence to therapy, severe immunocompromise, or if outpatient treatment is failing 1
• Once-daily dosing of ceftriaxone makes it particularly suitable for outpatient parenteral antibiotic therapy 5, 4

Alternative Regimens

• For patients with non-severe cellulitis, oral antibiotics targeting streptococci may be sufficient 1
• In cases where both streptococcal and staphylococcal (including MRSA) coverage is needed, alternative or additional agents may be required 1
• For patients with severe non-purulent cellulitis, vancomycin plus either piperacillin-tazobactam or imipenem/meropenem is recommended as empiric therapy 1

Ceftriaxone's once-daily dosing regimen, broad spectrum of activity, and established efficacy make it an excellent choice for the treatment of cellulitis, particularly in patients requiring parenteral therapy.