What is the recommended dosage and administration of ceftriaxone (Ceftriaxone) for pediatric patients?

Ceftriaxone Dosing in Pediatric Patients

For pediatric patients, ceftriaxone should be administered at 50-75 mg/kg/day once daily or divided every 12-24 hours for most infections, with dosage adjustments based on infection severity, site, and patient age. 1, 2

Age-Specific Dosing

• For neonates ≤7 days of age: 50 mg/kg/day given every 24 hours 1
• For neonates >7 days and ≤2000 g: 50 mg/kg/day given every 24 hours 1
• For neonates >7 days and >2000 g: 50-75 mg/kg/day given every 24 hours 1
• Ceftriaxone should not be used in hyperbilirubinemic neonates due to risk of bilirubin encephalopathy 1, 2

Indication-Specific Dosing

Meningitis

• 100 mg/kg/day divided every 12-24 hours (maximum 4 g daily) 1, 2
• Intravenous administration over 60 minutes in neonates to reduce risk of bilirubin encephalopathy 2
• Duration of therapy typically 7-14 days 2, 3

Respiratory Infections

• For pneumonia: 50-100 mg/kg/day once daily or divided every 12-24 hours 1, 4
• For pneumococcal pneumonia with penicillin resistance: 100 mg/kg/day given every 12-24 hours 1, 5

Skin and Soft Tissue Infections

• 50-75 mg/kg/day once daily (or divided twice daily) 2, 6
• Maximum total daily dose: 2 grams 2

Otitis Media

• Single intramuscular dose of 50 mg/kg (not to exceed 1 gram) 2

Other Serious Infections

• For bacteremia or arthritis: 50 mg/kg/day given daily for 7 days 1
• For complicated intra-abdominal infections and sepsis: 50-75 mg/kg/day given every 12-24 hours 1
• For gonococcal conjunctivitis in children ≤45 kg: 25-50 mg/kg IV or IM as a single dose (maximum 250 mg) 1

Pathogen-Specific Considerations

• For gram-negative enteric bacilli: 100 mg/kg/day divided every 12 hours or 80 mg/kg/day every 24 hours (maximum 4 g daily) 1
• For Streptococcus pneumoniae with penicillin MIC <2.0 μg/mL: 50-100 mg/kg/day every 12-24 hours 5
• For penicillin-resistant Streptococcus pneumoniae (MIC ≥4.0 μg/mL): 100 mg/kg/day every 12-24 hours 5
• For Haemophilus influenzae (β-lactamase producing): 50-100 mg/kg/day every 12-24 hours 5, 7

Administration Guidelines

• Intravenous doses should be administered over 30 minutes in pediatric patients 2
• In neonates, administer over 60 minutes to reduce risk of bilirubin encephalopathy 2
• For IV administration, reconstitute to concentrations between 10-40 mg/mL 2
• Do not use diluents containing calcium (e.g., Ringer's solution) due to risk of particulate formation 2

Clinical Efficacy and Safety

• Once-daily administration (50-80 mg/kg) has demonstrated 94-96% clinical cure rates in serious pediatric infections 7, 6
• Bacteriologic cure rates of 90-98% have been reported with once-daily dosing 7, 3, 8
• Common side effects include gastrointestinal symptoms and transient neutropenia 6

Important Considerations

• Duration of therapy typically ranges from 4-14 days depending on infection type and severity 2
• For Streptococcus pyogenes infections, treatment should continue for at least 10 days 2
• Once-daily dosing provides similar efficacy to divided doses with greater convenience 4, 6
• No dosage adjustment is necessary for patients with renal or hepatic impairment unless severe 2