Pediatric Dosing of Rocephin (Ceftriaxone)
For pediatric patients, the recommended dose of Rocephin (ceftriaxone) varies by age, weight, and indication, with standard dosing ranging from 50-100 mg/kg/day not exceeding 4 grams daily. 1, 2
Age-Specific Dosing
- For neonates with postnatal age ≤7 days: 50 mg/kg/day given every 24 hours 1
- For neonates with postnatal age >7 days and ≤2000 g: 50 mg/kg/day given every 24 hours 1
- For neonates with postnatal age >7 days and >2000 g: 50-75 mg/kg/day given every 24 hours 1
- Important: Ceftriaxone should not be used in hyperbilirubinemic neonates due to risk of bilirubin encephalopathy 1, 2
- For infants and children: Dosing depends on indication (see below) 2
Indication-Specific Dosing
- Bacterial meningitis: 100 mg/kg/day divided every 12-24 hours (maximum 4 g daily) 1, 2
- Severe infections including pneumonia: 50-100 mg/kg/day given once daily or divided every 12-24 hours 1, 2
- Less severe infections: 50-75 mg/kg/day given once daily or divided every 12-24 hours 1, 2
- Skin and skin structure infections: 50-75 mg/kg/day given once daily (or divided twice daily), not exceeding 2 grams daily 2
- Acute bacterial otitis media: Single intramuscular dose of 50 mg/kg (not to exceed 1 gram) 2
- Gonococcal conjunctivitis in children weighing ≤45 kg: 25-50 mg/kg IV or IM as a single dose, not exceeding 250 mg IM 1
Pathogen-Specific Considerations
- Streptococcus pneumoniae with penicillin MIC <2.0 μg/mL: 50-100 mg/kg/day every 12-24 hours 3
- Penicillin-resistant S. pneumoniae (MIC ≥4.0 μg/mL): 100 mg/kg/day every 12-24 hours 3
- Haemophilus influenzae (β-lactamase producing): 50-100 mg/kg/day every 12-24 hours 3
- Gram-negative enteric bacilli: 100 mg/kg/day divided every 12 hours or 80 mg/kg/day every 24 hours (up to 4 g daily) 1
Administration Guidelines
- Intravenous doses should be given over 30 minutes in children 2
- In neonates, administer over 60 minutes to reduce the risk of bilirubin encephalopathy 2
- For IV administration, concentrations between 10 mg/mL and 40 mg/mL are recommended 2
- Do not use diluents containing calcium (e.g., Ringer's solution) due to risk of particulate formation 2
Clinical Pearls and Caveats
- Recent evidence suggests that once-daily dosing is effective for most community-acquired pneumonia cases, with studies showing 96.8% probability of target attainment for susceptible pathogens (MIC 0.5 mg/L) with 100 mg/kg once daily 4
- For patients with enhanced renal clearance (eGFR >80 mL/min/1.73 m²) or when targeting less-susceptible pathogens, consider 50 mg/kg twice daily for improved target attainment 4
- Typical duration of therapy is 7-14 days, but may be longer for complicated infections 2
- When treating Streptococcus pyogenes infections, therapy should continue for at least 10 days 2
- Outpatient treatment with once-daily IM ceftriaxone has been shown to be effective for severe community-acquired pneumonia in children who are clinically stable 5