Recommended Dosage of Rocephin (Ceftriaxone) for Cellulitis
For cellulitis treatment, Rocephin (ceftriaxone) should be administered at 1-2 grams IV or IM once daily for 5 days, with extension if clinical improvement has not occurred within this time period. 1
Dosing Guidelines for Adults
- The usual adult daily dose is 1 to 2 grams given once a day (or in equally divided doses twice a day) depending on the type and severity of infection 2, 3
- The total daily dose should not exceed 4 grams 2, 3
- Generally, ceftriaxone therapy should be continued for at least 2 days after the signs and symptoms of infection have disappeared 2, 3
- The usual duration of therapy is 4 to 14 days; in complicated infections, longer therapy may be required 2, 3
Dosing Guidelines for Pediatric Patients
- For the treatment of skin and skin structure infections in children, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses twice a day) 2, 3
- The total daily dose should not exceed 2 grams in pediatric patients 2, 3
- A recent study showed that once-daily ceftriaxone (50 mg/kg) was effective for treating moderate to severe cellulitis in children in an outpatient setting 4
Administration Methods
Intramuscular Administration
- Reconstitute ceftriaxone powder with the appropriate diluent 2
- After reconstitution, each 1 mL of solution contains approximately 250 mg or 350 mg of ceftriaxone depending on the amount of diluent used 2
- Inject well within the body of a relatively large muscle 2
Intravenous Administration
- Administer intravenously by infusion over a period of 30 minutes 2, 3
- Concentrations between 10 mg/mL and 40 mg/mL are recommended 2, 3
Special Considerations
- No dosage adjustment is necessary for patients with impairment of renal or hepatic function 2, 3
- The dosages recommended for adults require no modification in elderly patients, up to 2 grams per day, provided there is no severe renal and hepatic impairment 2, 3
- For complicated skin and soft tissue infections, vancomycin plus either piperacillin-tazobactam or imipenem/meropenem may be considered for empiric therapy 1
Treatment Duration and Monitoring
- A 5-day course of antimicrobial therapy is recommended for cellulitis, with extension if clinical improvement has not occurred within this time period 1
- Once-daily regimen of ceftriaxone (1 g IV) has been shown to be effective for moderate-to-severe cellulitis in adults 5
- Monitor for signs of clinical improvement, including reduction in erythema and swelling, decreased pain and tenderness, and resolution of systemic symptoms if present 6
Important Adjunctive Measures
- Elevation of the affected area is an important and often neglected aspect of treatment that quickens improvement by promoting gravity drainage of edema and inflammatory substances 7, 1
- Treat any underlying conditions that may have predisposed to the infection, such as tinea pedis, venous eczema, or trauma 7
- For patients with recurrent cellulitis, address predisposing factors such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities 1, 6
Hospitalization Criteria
- Consider hospitalization if there is concern for deeper or necrotizing infection, poor adherence to therapy, severe immunocompromise, or if outpatient treatment is failing 1
- Patients with systemic toxicity and/or rapidly progressive or worsening infection despite receipt of appropriate oral antibiotics should be managed as inpatients 7
Cautions and Contraindications
- Do not use diluents containing calcium, such as Ringer's solution or Hartmann's solution, to reconstitute ceftriaxone as a precipitate can form 2, 3
- Ceftriaxone must not be administered simultaneously with calcium-containing IV solutions 2, 3
- Hyperbilirubinemic neonates, especially prematures, should not be treated with ceftriaxone 2, 3