What is the recommended pediatric dose of ceftriaxone (a third-generation cephalosporin antibiotic)?

Pediatric Dosing of Ceftriaxone

The recommended pediatric dose of ceftriaxone is 50-75 mg/kg/day given once daily or divided every 12-24 hours, with a maximum daily dose of 2 grams for most infections and 4 grams for meningitis. 1, 2, 3

Age-Specific Dosing

• Neonates:

  • Postnatal age ≤7 days: 50 mg/kg/day given every 24 hours 1, 2
  • Postnatal age >7 days and ≤2000 g: 50 mg/kg/day given every 24 hours 1, 2
  • Postnatal age >7 days and >2000 g: 50-75 mg/kg/day given every 24 hours 1, 2
  • Important: Ceftriaxone should not be used in hyperbilirubinemic neonates 1, 2

• Infants and Children:

  • Standard dose: 50-75 mg/kg/day divided every 12-24 hours 1, 3
  • Maximum daily dose: 2 grams for most infections 3

Indication-Specific Dosing

• Meningitis: 100 mg/kg/day divided every 12-24 hours (maximum 4 grams daily) 2, 3

  • Higher dosing ensures adequate cerebrospinal fluid penetration 4
  • CSF sterilization rates of 96-100% have been reported with this dosing 5, 4

• Skin and skin structure infections: 50-75 mg/kg/day given once daily or divided twice daily (maximum 2 grams daily) 3

• Acute bacterial otitis media: Single intramuscular dose of 50 mg/kg (not to exceed 1 gram) 3

• Serious infections (other than meningitis): 50-75 mg/kg/day divided every 12 hours (maximum 2 grams daily) 3, 6

• Pneumonia, septicemia, osteomyelitis: 50-80 mg/kg once daily has shown 94% clinical cure rates 6

Administration Considerations

• Intravenous administration: Should be given over 30 minutes 3

  • Exception: In neonates, administer over 60 minutes to reduce risk of bilirubin encephalopathy 3

• Intramuscular administration: Reconstitute with appropriate diluent and inject well within a relatively large muscle 3

• Duration of therapy:

  • Generally 7-14 days for most infections 3
  • For meningitis, typically 7-14 days 2, 4
  • For Streptococcus pyogenes infections, at least 10 days 3

Special Considerations

• For critically ill children, the standard 100 mg/kg once-daily dose provides adequate exposure for most susceptible pathogens 7

• In patients with enhanced renal function (eGFR >80 mL/min/1.73 m²) or when treating less-susceptible pathogens (MIC ≥0.5 mg/L), consider 50 mg/kg twice daily to improve target attainment 7

• No dosage adjustment is necessary for patients with impaired renal or hepatic function 3

Potential Adverse Effects

• Gastrointestinal effects: Gut sterilization with Candida overgrowth reported in 35% of neonates and infants 5

• Prolonged fever reported in approximately 13% of pediatric patients 5

• Generally well-tolerated with no serious side effects requiring discontinuation of therapy 6, 8