Ceftriaxone Dosing for Hand Injury Awaiting Surgery

For a hand injury awaiting surgery, the recommended dose of ceftriaxone is 1-2 grams intravenously every 24 hours. 1, 2

Dosing Recommendations

For adults with skin and soft tissue infections, including hand injuries, ceftriaxone should be administered at a dose of 1-2 grams intravenously once daily, depending on the severity of infection 1, 2
The total daily dose should not exceed 4 grams in adults 2
For surgical prophylaxis, a single dose of 1 gram administered intravenously 1/2 to 2 hours before surgery is recommended 2
Treatment should generally be continued for at least 2 days after signs and symptoms of infection have disappeared, with usual duration of therapy being 4-14 days 2

Ceftriaxone should be administered intravenously by infusion over a period of 30 minutes 2
Concentrations between 10 mg/mL and 40 mg/mL are recommended for intravenous administration 2
Do not use diluents containing calcium, such as Ringer's solution or Hartmann's solution, to reconstitute ceftriaxone as precipitation can form 2

For skin and soft tissue infections of the extremities, ceftriaxone is an appropriate choice when waiting for surgery 1
For hand injuries with suspected polymicrobial infection, broader coverage may be needed by adding metronidazole 500 mg every 8 hours IV 1
If MRSA is suspected, consider adding vancomycin 15 mg/kg every 12 hours IV 1

If ceftriaxone is not available or contraindicated, alternative options include:
- Cefazolin 0.5-1 g every 8 h IV (for injuries away from axilla) 1
- Ampicillin-sulbactam 3 g every 6 h IV 1
- Piperacillin-tazobactam 3.375 g every 6 h or 4.5 g every 8 h IV 1

For children with skin and soft tissue infections, the recommended total daily dose is 50-75 mg/kg given once daily (or in equally divided doses twice a day) 2
The total daily dose should not exceed 2 grams in pediatric patients 2

For hand injuries awaiting surgery, ceftriaxone should be continued until surgery and potentially postoperatively depending on intraoperative findings 1
Generally, therapy should be continued for at least 2 days after signs and symptoms of infection have disappeared 2
In complicated infections, longer therapy may be required (up to 14 days) 2

Ceftriaxone has a long half-life which allows for once-daily dosing in most infections, providing convenience and potential cost savings 3, 4
No dosage adjustment is necessary for patients with impairment of renal or hepatic function 2
Ceftriaxone is contraindicated in hyperbilirubinemic neonates and premature infants 1, 2
Single-dose prophylaxis with ceftriaxone has been shown to be effective for surgical prophylaxis in orthopedic procedures 5
Be aware that ceftriaxone must not be administered simultaneously with calcium-containing IV solutions via the same line 2