What is the dosage and treatment duration of Rocephin (ceftriaxone) for broad-spectrum infections?

Rocephin (Ceftriaxone) Dosing for Broad-Spectrum Infections

For most adult broad-spectrum infections, administer ceftriaxone 1-2 grams IV or IM once daily, with the specific dose and frequency determined by infection severity and location. 1, 2

Standard Adult Dosing Algorithm

Step 1: Assess Infection Severity and Location

For uncomplicated infections (skin/soft tissue, UTI, community-acquired pneumonia):

• Administer 1 gram IV/IM once daily 1, 2
• Maximum total daily dose should not exceed 4 grams 1, 2
• Continue therapy for at least 2 days after signs and symptoms resolve 1, 2
• Typical duration is 4-14 days; complicated infections may require longer 1, 2

For serious infections requiring higher dosing:

• Administer 1-2 grams IV/IM once daily (or divided twice daily) 1, 2
• The broad spectrum covers most Gram-positive and Gram-negative aerobic bacteria, though activity against Gram-positive organisms is less than first/second-generation cephalosporins 3

Step 2: Adjust for CNS Infections (Meningitis)

For bacterial meningitis:

• Administer 2 grams IV every 12 hours (total 4 grams daily) 4
• Initial pediatric dose: 100 mg/kg (not exceeding 4 grams) 1, 2
• Maintenance: 100 mg/kg/day (not exceeding 4 grams daily) 1, 2
• Duration: 7-14 days, extended if patient not responding by day 10 4, 1, 2

Pathogen-specific meningitis dosing:

• Pneumococcal: 2 grams IV every 12 hours for 10-14 days 4
• Meningococcal: 2 grams IV every 12 hours for 5 days 4
• H. influenzae: 2 grams IV every 12 hours for 10 days 4
• Enterobacteriaceae: 2 grams IV every 12 hours for 21 days 4

Step 3: Consider Special Infection Types

For disseminated gonococcal infection:

• Initial: 1 gram IM/IV every 24 hours 4
• Continue for 24-48 hours after improvement, then switch to oral therapy to complete 7 days total 4

For gonococcal endocarditis:

• Administer 1-2 grams IV every 12 hours for at least 4 weeks 4

For uncomplicated gonorrhea:

• Single dose of 250 mg IM 1, 2
• Note: If Chlamydia trachomatis suspected, add appropriate antichlamydial coverage as ceftriaxone has no activity against this organism 1, 2

For endocarditis (highly penicillin-susceptible viridans streptococci):

• Monotherapy: 2 grams IV/IM once daily for 4 weeks 4
• Combination therapy: 2 grams IV/IM once daily for 2 weeks plus gentamicin 3 mg/kg daily for 2 weeks (not for patients with cardiac/extracardiac abscess, creatinine clearance <20 mL/min, or eighth cranial nerve dysfunction) 4

Pediatric Dosing

For skin/soft tissue infections:

• 50-75 mg/kg once daily (or divided twice daily), not exceeding 2 grams total daily 1, 2

For acute bacterial otitis media:

• Single IM dose of 50 mg/kg (not exceeding 1 gram) 1, 2

For serious infections (excluding meningitis):

• 50-75 mg/kg divided every 12 hours, not exceeding 2 grams total daily 1, 2

For children with bacteremia/arthritis:

• Children <45 kg: 50 mg/kg (maximum 1 gram) IM/IV daily for 7 days 4
• Children ≥45 kg: Use adult dosing 4

For gonococcal infections in children:

• <45 kg with uncomplicated infection: 125 mg IM single dose 5
• <45 kg with bacteremia/arthritis: 50 mg/kg (maximum 1 gram) IM/IV daily for 7 days 5

Neonatal Considerations

Critical contraindications:

• Do NOT use in hyperbilirubinemic neonates, especially premature infants 1, 2
• Contraindicated in premature neonates 1, 2
• Contraindicated in neonates ≤28 days requiring calcium-containing IV solutions due to precipitation risk 1, 2

When ceftriaxone is necessary in neonates:

• Administer IV doses over 60 minutes (not 30 minutes) to reduce bilirubin encephalopathy risk 1, 2
• For neonatal gonococcal infections: 25-50 mg/kg/day IV or IM in single daily dose for 7 days (10-14 days if meningitis documented) 4

Administration Guidelines

Intravenous administration:

• Infuse over 30 minutes for adults and children 1, 2
• Infuse over 60 minutes for neonates 1, 2
• Recommended concentrations: 10-40 mg/mL (lower concentrations acceptable) 1, 2

Intramuscular administration:

• Inject deep into large muscle mass 1, 2
• Aspirate to avoid intravascular injection 1, 2
• After reconstitution: 250 mg/mL or 350 mg/mL concentrations available 1, 2

Critical Pitfalls to Avoid

Calcium-containing solutions:

• NEVER use Ringer's solution or Hartmann's solution for reconstitution 1, 2
• NEVER administer simultaneously with calcium-containing IV solutions via Y-site 1, 2
• In non-neonates, may administer sequentially if lines thoroughly flushed between infusions 1, 2

Penicillin-resistant pneumococci:

• Add vancomycin 15-20 mg/kg IV twice daily OR rifampicin 600 mg twice daily to ceftriaxone regimen 4

Listeria coverage in elderly:

• For patients ≥60 years with suspected meningitis, add amoxicillin 2 grams IV every 4 hours 4

Pseudomonas aeruginosa:

• Ceftriaxone has limited activity; do NOT use as sole therapy for pseudomonal infections 3

Duration of Therapy

Standard infections:

• Continue for at least 2 days after symptom resolution 1, 2
• Usual duration: 4-14 days 1, 2

Streptococcus pyogenes infections:

• Continue for at least 10 days 1, 2

Extended therapy indications:

• Complicated infections may require longer than 14 days 1, 2
• Meningitis not responding by day 10 requires extended duration 4

Renal/Hepatic Impairment

No dosage adjustment necessary for renal or hepatic impairment alone 1, 2

Exception: Dosages up to 2 grams per day require no modification in elderly patients unless severe combined renal AND hepatic impairment present 1, 2