What is the dosage and treatment regimen for Rocephin (ceftriaxone) in adults with severe bacterial infections?

Rocephin (Ceftriaxone) Dosing for Severe Bacterial Infections in Adults

For severe bacterial infections in adults, administer ceftriaxone 2 grams IV every 12 hours (total 4 grams daily), with specific dosing adjustments based on the infection type and pathogen identified. 1, 2

Standard Dosing by Infection Type

Central Nervous System Infections

• Bacterial meningitis: 2 grams IV every 12 hours for 10-14 days 1, 2

  • Continue for 10 days if clinically stable
  • Extend to 14 days if slower clinical response 1
  • For penicillin-resistant pneumococci, add vancomycin 15-20 mg/kg IV twice daily OR rifampicin 600 mg twice daily 1, 2

• Meningococcal meningitis: 2 grams IV every 12 hours for 5 days 1

  • May discontinue after 5 days if patient has recovered 1

• Haemophilus influenzae meningitis: 2 grams IV every 12 hours for 10 days 1, 2

• Enterobacteriaceae CNS infections: 2 grams IV every 12 hours for 21 days 1, 2

  • Seek specialist advice regarding local resistance patterns 1
  • Consider meropenem 2 grams IV every 8 hours if ESBL suspected 1

Gonococcal Infections

• Disseminated gonococcal infection: 1 gram IM or IV every 24 hours 2

  • Continue for 24-48 hours after clinical improvement begins
  • Then switch to oral therapy to complete 7 days total 2

• Gonococcal meningitis/endocarditis: 1-2 grams IV every 12 hours 2

  • 10-14 days for meningitis
  • At least 4 weeks for endocarditis 2

• Uncomplicated gonococcal infections: 250 mg IM as single dose 2, 3

Endocarditis

• Highly penicillin-susceptible viridans streptococci (MIC ≤0.12 μg/mL): 2 grams IV/IM once daily for 4 weeks 2

• HACEK organisms: 2 grams IV/IM once daily for 4 weeks (6 weeks for prosthetic valve) 2

General Severe Infections

• Standard adult dosing: 1-2 grams IV once daily or divided twice daily 3
  • Maximum daily dose: 4 grams 3
  • Adjust based on infection severity and pathogen 2

Critical Special Populations

Elderly Patients (≥60 years)

• When meningitis is suspected, add amoxicillin 2 grams IV every 4 hours to cover Listeria monocytogenes 1, 4
• No dose adjustment needed for age alone if renal/hepatic function normal 3

Immunocompromised Patients

• Add ampicillin to ceftriaxone for empiric Listeria coverage 4

Neonates

• Contraindicated in hyperbilirubinemic neonates and premature infants 3
• Contraindicated in neonates ≤28 days requiring calcium-containing IV solutions 3
• If used: infuse over 60 minutes (not 30) to reduce bilirubin encephalopathy risk 3

Administration Guidelines

Intravenous Administration

• Infuse over 30 minutes in adults 3
• Infuse over 60 minutes in neonates 3
• Recommended concentration: 10-40 mg/mL 3

Critical Safety Warning

• Never mix with calcium-containing solutions (Ringer's, Hartmann's, parenteral nutrition) 3
• Ceftriaxone-calcium precipitation can be fatal 3
• In non-neonates, may give sequentially if lines thoroughly flushed between infusions 3

Duration of Therapy Considerations

• Continue therapy at least 2 days after signs/symptoms resolve 3
• Typical duration: 4-14 days for most infections 3
• Streptococcus pyogenes infections: minimum 10 days 3
• Extend treatment duration if patient not responding adequately 1, 4

Renal/Hepatic Impairment

• No dosage adjustment necessary for renal or hepatic impairment alone 3
• Exception: severe combined renal and hepatic impairment may require adjustment 3

Common Pitfalls to Avoid

1. Underdosing CNS infections: Always use 2 grams every 12 hours (4 grams daily total) for meningitis, not once-daily dosing 1, 2

2. Missing Listeria coverage: In elderly or immunocompromised patients with meningitis, ceftriaxone has NO activity against Listeria—must add ampicillin/amoxicillin 1, 4

3. Calcium co-administration: Fatal precipitates can form; this is an absolute contraindication in neonates and requires careful line management in adults 3

4. Premature discontinuation: Treatment failures reported with inadequate duration, particularly for resistant organisms 2

5. Resistant pneumococci: When suspected (recent travel from high-resistance areas), add vancomycin or rifampicin empirically 1, 2