Ceftriaxone Dosing Recommendations
The recommended dosage of ceftriaxone varies by indication, with standard adult dosing ranging from 1-2 grams IV/IM once daily for most infections, while specific conditions like bacterial meningitis require higher doses of 2 grams IV every 12 hours, and treatment duration varies from a single dose for uncomplicated gonorrhea to 7-14 days for most serious infections.
Adult Dosing Guidelines by Indication
Standard Infections
- For most adult infections, ceftriaxone should be dosed at 1-2 grams intravenously or intramuscularly every 24 hours 1
- The total daily dose should not exceed 4 grams 2
- Generally, ceftriaxone therapy should be continued for at least 2 days after signs and symptoms of infection have disappeared, with usual duration of 4-14 days 2
Specific Infections
- Uncomplicated gonococcal infections: Single intramuscular dose of 250 mg 2
- Disseminated gonococcal infection: 1 gram IM or IV every 24 hours, continued for 24-48 hours after improvement begins 1
- Gonococcal meningitis: 1-2 grams IV every 12 hours for 10-14 days 1
- Gonococcal endocarditis: 1-2 grams IV every 12 hours for at least 4 weeks 1
- Bacterial meningitis: 2 grams IV every 12 hours (total 4g daily) for 10-14 days 1
- Surgical prophylaxis: Single dose of 1 gram IV administered 30 minutes to 2 hours before surgery 2
Pediatric Dosing Guidelines
General Infections
- For skin and skin structure infections: 50-75 mg/kg once daily (or divided twice daily), not to exceed 2 grams total daily dose 2
- For serious infections other than meningitis: 50-75 mg/kg daily in divided doses every 12 hours, not to exceed 2 grams total daily dose 2
Specific Pediatric Indications
- Meningitis: Initial dose of 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) for 7-14 days 2
- Acute bacterial otitis media: Single intramuscular dose of 50 mg/kg (not to exceed 1 gram) 2
- Neonatal gonococcal infections: 25-50 mg/kg/day IV or IM in a single daily dose for 7 days (10-14 days if meningitis is documented) 1
Special Populations and Considerations
Elderly Patients
- No dosage adjustment is necessary for elderly patients, up to 2 grams per day, provided there is no severe renal and hepatic impairment 2
Renal and Hepatic Impairment
- No dosage adjustment is necessary for patients with impairment of renal or hepatic function alone 2
- Dosage modification is necessary only when there is combined hepatic and renal dysfunction 3
Resistant Organisms
- For ceftriaxone-resistant strains, higher doses may be required, with twice-daily dosing of 2 grams potentially needed 1
- Treatment failures have been reported with ceftriaxone doses between 250-500 mg, particularly for pharyngeal infections with elevated MICs 4
Administration Guidelines
Intravenous Administration
- Should be administered over a period of 30 minutes 2
- In neonates, administer over 60 minutes to reduce the risk of bilirubin encephalopathy 2
- Concentrations between 10 mg/mL and 40 mg/mL are recommended 2
Intramuscular Administration
- Inject well within the body of a relatively large muscle 2
- Aspiration helps to avoid unintentional injection into a blood vessel 2
Important Precautions
- Do not use diluents containing calcium, such as Ringer's solution or Hartmann's solution, to reconstitute ceftriaxone 2
- Ceftriaxone must not be administered simultaneously with calcium-containing IV solutions 2
- Contraindicated in hyperbilirubinemic neonates, especially prematures 2
- Contraindicated in neonates (≤28 days) if they require treatment with calcium-containing IV solutions 2
Clinical Efficacy and Safety
- Ceftriaxone has been effective in treating a wide range of infections with bacteriologic and clinical success rates consistently exceeding 90% 3
- The long half-life (5.8-8.7 hours, mean 6.5 hours) allows for less frequent dosing than other antimicrobials 3
- Common adverse effects include diarrhea, eosinophilia, thrombocytosis, and elevated liver enzymes 5