Rocephin (Ceftriaxone) Dosing for Pneumonia
For pneumonia treatment, ceftriaxone (Rocephin) should be administered at 50-100 mg/kg/day every 12-24 hours for children, and 1-2 grams daily for adults, with 1 gram daily being equally effective as 2 grams daily for most cases of community-acquired pneumonia. 1, 2, 3
Pediatric Dosing
Standard Dosing for Community-Acquired Pneumonia (CAP):
- For most cases of pediatric CAP: 50-100 mg/kg/day given every 12-24 hours 1
- For penicillin-resistant S. pneumoniae (MICs ≥4.0 μg/mL): 100 mg/kg/day every 12-24 hours 1
- Maximum daily dose should not exceed 2 grams for most infections, except meningitis 2
- For severe infections including empyema: Consider higher dosing within the recommended range 1
Specific Pathogen-Based Dosing:
- For S. pneumoniae with penicillin MICs >2.0 μg/mL: 50-100 mg/kg/day every 12-24 hours 1
- For Group A Streptococcus: 50-100 mg/kg/day every 12-24 hours 1
- For H. influenzae (β-lactamase producing): 50-100 mg/kg/day every 12-24 hours 1
Duration of Therapy:
- Generally 7-14 days for most pneumonias 2
- Continue therapy for at least 2 days after signs and symptoms of infection have disappeared 2
- For S. pyogenes infections, continue for at least 10 days 2
Adult Dosing
Standard Dosing for Community-Acquired Pneumonia:
- 1-2 grams given once daily (or in equally divided doses twice a day) 2, 3
- Recent evidence shows that 1 gram daily is as effective as 2 grams daily for most community-acquired pneumonia cases 3, 4
- Total daily dose should not exceed 4 grams 2
Benefits of Lower Dosing:
- 1 gram daily dosing is associated with similar mortality rates as 2 grams daily 4
- Lower dosing (1 gram daily) shows decreased rates of C. difficile infection (0.2% vs 0.6%) 4
- Shorter hospital length of stay with 1 gram daily dosing (median 4 days vs 5 days) 4
Administration Methods
Intramuscular Administration:
- Reconstitute with appropriate diluent 2
- For 1 gram dose: Add 3.6 mL diluent to achieve 250 mg/mL concentration 2
- For 2 gram dose: Add 7.2 mL diluent to achieve 250 mg/mL concentration 2
- Inject well within the body of a relatively large muscle 2
Intravenous Administration:
- Administer by infusion over a period of 30 minutes 2
- For neonates: Administer over 60 minutes to reduce risk of bilirubin encephalopathy 2
- Recommended concentrations between 10 mg/mL and 40 mg/mL 2
- For 1 gram dose: Add 9.6 mL diluent 2
- For 2 gram dose: Add 19.2 mL diluent 2
Special Considerations
Combination Therapy:
- Consider adding a macrolide for atypical pathogen coverage (Mycoplasma pneumoniae, Chlamydophila pneumoniae) 1
- For suspected MRSA: Add vancomycin or clindamycin based on local susceptibility patterns 1
Contraindications and Precautions:
- Do not use diluents containing calcium (e.g., Ringer's solution or Hartmann's solution) 2
- Contraindicated in hyperbilirubinemic neonates, especially prematures 2
- Contraindicated in neonates (≤28 days) requiring calcium-containing IV solutions 2
- No dosage adjustment necessary for patients with impairment of renal or hepatic function 2
Clinical Pearls:
- Once-daily dosing is as effective as multiple daily doses due to ceftriaxone's long half-life 5, 3
- In areas with low prevalence of drug-resistant S. pneumoniae, 1 gram daily may be sufficient 4
- Ceftriaxone is incompatible with vancomycin, amsacrine, aminoglycosides, and fluconazole in admixtures 2