Maximum Ceftriaxone Dosage Per Day
The maximum recommended dose of ceftriaxone is 4 grams per day for adults and pediatric patients with serious infections such as meningitis. 1, 2
Adult Dosing Guidelines
- The usual adult daily dose ranges from 1 to 2 grams given once daily or in equally divided doses twice daily, depending on the type and severity of infection 1
- For serious infections including meningitis, the maximum daily dose should not exceed 4 grams 1
- For CNS infections, French guidelines recommend 75-100 mg/kg/day without an upper limit, though clinical studies have shown good tolerability with median dosages of 96.4 mg/kg/day (approximately 7 g/day) 3
- No dosage adjustment is necessary for elderly patients up to 2 grams per day, provided there is no severe renal or hepatic impairment 1
Pediatric Dosing Guidelines
- For bacterial meningitis in pediatric patients, the recommended dose is 100 mg/kg/day (not to exceed 4 grams daily) 1, 2
- For less severe infections in pediatric patients, the recommended dose is 50-75 mg/kg/day (not to exceed 2 grams daily) 1, 4
- For severe infections including pneumonia, the recommended dose is 50-100 mg/kg/day (not to exceed 4 grams daily) 2, 4
Indication-Specific Considerations
- For treatment of skin and skin structure infections in pediatric patients, the recommended total daily dose is 50 to 75 mg/kg given once daily or in equally divided doses twice daily, not to exceed 2 grams 1
- For uncomplicated gonococcal infections in adults, a single intramuscular dose of 250 mg is recommended 1
- For surgical prophylaxis, a single dose of 1 gram administered intravenously 1/2 to 2 hours before surgery is recommended 1
Special Populations
- In patients with renal impairment receiving high-dose ceftriaxone, caution should be exercised as drug accumulation may occur 5
- For patients on dialysis, plasma concentrations of ceftriaxone should be monitored to determine if dosage adjustments are necessary 6
- Ceftriaxone is contraindicated in hyperbilirubinemic neonates and premature neonates 1
Administration Considerations
- Intravenous doses should be administered over a period of 30 minutes in adults 1
- In neonates, administration should be over 60 minutes to reduce the risk of bilirubin encephalopathy 1
- Do not use diluents containing calcium, such as Ringer's solution or Hartmann's solution, to reconstitute ceftriaxone 1
Clinical Pearls
- Single daily dosing of ceftriaxone (up to 4 g/day) has been shown to be effective for bacterial meningitis in adults 7
- Ceftriaxone exhibits an exceptionally long elimination half-life (5.8 to 8.7 hours), which supports once-daily dosing regimens 6
- In critically ill patients with normal renal function, ceftriaxone clearance may be increased, potentially requiring more frequent dosing 5
- High-dose ceftriaxone (≥4 g or ≥75 mg/kg daily) for CNS infections has shown good tolerability with only 8.7% of patients experiencing adverse drug reactions 3
Remember that while some studies have explored higher doses in specific clinical scenarios, the FDA-approved maximum dose remains 4 grams per day for adults and pediatric patients with serious infections.