How is ceftriaxone administered?

Ceftriaxone Administration Guidelines

Ceftriaxone should be administered intravenously by infusion over a period of 30 minutes or intramuscularly, with dosing typically once daily for most adult infections due to its long half-life. 1, 2

Routes of Administration

• Ceftriaxone can be administered via two routes:
  • Intravenous (IV): Administered by infusion over 30 minutes 1
  • Intramuscular (IM): Completely absorbed following administration with peak plasma concentrations occurring between 2-3 hours post-dosing 2, 3

Intravenous Administration

• Reconstitute with appropriate IV diluent (sterile water for injection, 0.9% sodium chloride, or 5% dextrose) 1
• Recommended concentration is between 10-40 mg/mL 1
• For standard vial reconstitution:
  • 250 mg vial: Add 2.4 mL diluent
  • 500 mg vial: Add 4.8 mL diluent
  • 1 gram vial: Add 9.6 mL diluent
  • 2 gram vial: Add 19.2 mL diluent 1
• After reconstitution, each 1 mL contains approximately 100 mg of ceftriaxone 1
• Administer over 30 minutes for adults and children 1
• For neonates, administer over 60 minutes to reduce risk of bilirubin encephalopathy 1

Intramuscular Administration

• Reconstitute with appropriate diluent to achieve concentration of 250 mg/mL or 350 mg/mL 1
• For standard vial reconstitution to 250 mg/mL:
  • 250 mg vial: Add 0.9 mL diluent
  • 500 mg vial: Add 1.8 mL diluent
  • 1 gram vial: Add 3.6 mL diluent
  • 2 gram vial: Add 7.2 mL diluent 1
• Inject well within the body of a relatively large muscle 1
• Aspiration before injection helps avoid unintentional injection into a blood vessel 1

Dosing Guidelines

Adult Dosing

• Standard adult daily dose: 1-2 grams given once daily (or divided twice daily) depending on infection type and severity 4
• For bacterial meningitis: 2 grams IV every 12 hours 4
• For uncomplicated gonococcal infections: Single 250 mg IM dose 4
• For preoperative prophylaxis: Single 1 gram IV dose 30 minutes to 2 hours before surgery 1

Pediatric Dosing

• For most infections: 50-75 mg/kg/day given once daily or divided twice daily 1
• For meningitis: Initial dose of 100 mg/kg (not exceeding 4 grams), then 100 mg/kg/day (not exceeding 4 grams daily) 1
• Total daily dose should not exceed 2 grams for most infections and 4 grams for meningitis 1

Compatibility and Storage

• Do not use diluents containing calcium (e.g., Ringer's solution or Hartmann's solution) due to risk of particulate formation 1
• Incompatible with vancomycin, amsacrine, aminoglycosides, and fluconazole in admixtures 1
• When administering these drugs concomitantly, give sequentially with thorough flushing of IV lines between administrations 1
• After reconstitution, IV solutions remain stable for:
  • 2 days at room temperature (25°C)
  • 10 days when refrigerated (4°C) 1
• Reconstituted IM solutions remain stable for:
  • 24 hours at room temperature with most diluents
  • 3-10 days when refrigerated, depending on diluent 1

Special Considerations

• No dosage adjustment is necessary for elderly patients or those with impaired renal or hepatic function when using up to 2 grams per day 1, 3
• Multiple dosing at 12- or 24-hour intervals results in 15-36% accumulation of ceftriaxone in plasma 2, 3
• The long half-life (5.8-8.7 hours) allows for once-daily dosing in most adults, which can provide cost savings and improved convenience 3, 5
• For patients on hemodialysis, plasma concentrations should be monitored as elimination rate may be significantly reduced in some patients 3

By following these administration guidelines, ceftriaxone can be effectively used to treat a wide range of serious infections with minimal adverse effects.