What is the recommended dosing for Rocephin (Ceftriaxone)?

Ceftriaxone (Rocephin) Dosing Guidelines

The recommended dosing for Rocephin (Ceftriaxone) varies by patient age, weight, and infection type, with standard adult dosing being 1-2 grams IV/IM daily or divided twice daily, and pediatric dosing typically 50-100 mg/kg/day depending on infection severity. 1, 2

Adult Dosing

Standard Infections

• 1-2 grams IV/IM once daily or divided twice daily, not to exceed 4 grams daily 2
• For most infections, treatment should continue for at least 2 days after symptoms resolve, with typical duration of 4-14 days 2
• For Streptococcus pyogenes infections, continue therapy for at least 10 days 2

Specific Infections

• Uncomplicated gonorrhea: 250 mg IM as a single dose 2, 3
• Disseminated gonococcal infection (DGI): 1 gram IM/IV daily for 24-48 hours after improvement begins, then switch to oral therapy to complete 7 days 1, 4
• Bacterial meningitis: 2 grams IV every 12 hours (total 4 grams daily) 1, 4
• Gonococcal meningitis: 1-2 grams IV every 12 hours for 10-14 days 1
• Gonococcal endocarditis: 1-2 grams IV every 12 hours for at least 4 weeks 1
• Surgical prophylaxis: 1 gram IV 30 minutes to 2 hours before surgery 2

Pediatric Dosing

Weight-Based Recommendations

• Children weighing ≥45 kg: Use adult dosing regimens 5
• Children weighing <45 kg with uncomplicated gonococcal infections: 125 mg IM as a single dose 5
• Children with bacteremia, arthritis, or meningitis who weigh <45 kg: 50 mg/kg (maximum 1 gram) IM/IV daily for 7 days 5
• For meningitis: Extend treatment to 10-14 days 5

Infection-Specific Pediatric Dosing

• Skin and skin structure infections: 50-75 mg/kg/day once daily or divided twice daily, not to exceed 2 grams daily 2
• Acute bacterial otitis media: 50 mg/kg IM as a single dose (maximum 1 gram) 2
• Serious infections other than meningitis: 50-75 mg/kg/day divided every 12 hours, not to exceed 2 grams daily 2
• Meningitis: Initial dose of 100 mg/kg (maximum 4 grams), then 100 mg/kg/day (maximum 4 grams daily) for 7-14 days 2, 6

Neonatal Dosing

• For neonatal gonococcal infections: 25-50 mg/kg/day IV/IM as a single daily dose for 7 days (10-14 days if meningitis is documented) 1
• Intravenous doses should be administered over 60 minutes in neonates to reduce risk of bilirubin encephalopathy 2
• Caution: Ceftriaxone is contraindicated in hyperbilirubinemic neonates, especially premature infants 2

Special Considerations

Administration

• IV administration should be over 30 minutes (60 minutes for neonates) 2
• Do not use diluents containing calcium (e.g., Ringer's solution) to reconstitute ceftriaxone 2
• Ceftriaxone must not be administered simultaneously with calcium-containing IV solutions 2

Dosage Adjustments

• No dosage adjustment necessary for patients with renal or hepatic impairment up to 2 grams per day, unless severe 2, 7
• Elderly patients require no modification up to 2 grams per day, provided there is no severe renal or hepatic impairment 2
• For ceftriaxone-resistant strains, higher doses with twice-daily administration may be required 1

Pharmacokinetics

• Exhibits exceptionally long elimination half-life (5.8-8.7 hours) 7
• 33-67% excreted unchanged in urine, remainder secreted in bile 7
• Rapidly and completely absorbed following IM administration 7

Common Pitfalls

• Treatment failures have been reported with lower doses (250-500 mg), particularly for pharyngeal infections 1
• Small percentage of patients on dialysis may have significantly reduced elimination rates, requiring monitoring of plasma concentrations 7
• Ceftriaxone is not significantly removed by hemodialysis 7
• For penicillin-allergic patients with neurosyphilis, ceftriaxone 2g daily either IM or IV for 10-14 days can be used as an alternative treatment 1