Ceftriaxone Pediatric Dosing
For most pediatric infections, use 50-75 mg/kg/day given once daily, but for bacterial meningitis specifically, use 100 mg/kg/day divided every 12-24 hours (maximum 4 g daily). 1
Age-Specific Dosing for Neonates
For neonates, dosing must be adjusted based on postnatal age and weight:
- Neonates ≤7 days old: 50 mg/kg/day given every 24 hours 1
- Neonates >7 days and ≤2000 g: 50 mg/kg/day given every 24 hours 1
- Neonates >7 days and >2000 g: 50-75 mg/kg/day given every 24 hours 1
Critical caveat: Never use ceftriaxone in hyperbilirubinemic neonates due to risk of kernicterus from displacement of bilirubin from albumin binding sites. 1
Indication-Specific Dosing for Infants and Children
Bacterial Meningitis (Most Important)
Use 100 mg/kg/day divided every 12-24 hours (maximum 4 g daily) 1. Recent pharmacokinetic modeling demonstrates that once-daily dosing achieves superior CSF penetration compared to twice-daily dosing, with 88% probability of target attainment at 24 hours versus 53% for twice-daily regimens. 2 The American Academy of Pediatrics supports either 100 mg/kg/day divided every 12 hours or 80 mg/kg/day every 24 hours (up to 4 g daily). 1
Severe Infections (Pneumonia, Sepsis)
Use 50-100 mg/kg/day given once daily or divided every 12-24 hours 1. For pneumococcal pneumonia with penicillin resistance, increase to 100 mg/kg/day every 12-24 hours. 1
Less Severe Infections
Use 50-75 mg/kg/day given once daily or divided every 12-24 hours 1. This includes:
- Complicated intra-abdominal infections 1
- Community-acquired pneumonia 1
- Cellulitis 3, 4
- Urinary tract infections 3
Pathogen-Specific Considerations
When specific pathogens are identified:
- Streptococcus pneumoniae with penicillin MIC <2.0 μg/mL: 50-100 mg/kg/day every 12-24 hours 5
- Penicillin-resistant S. pneumoniae (MIC ≥4.0 μg/mL): 100 mg/kg/day every 12-24 hours 5
- Group A Streptococcus: 50-100 mg/kg/day every 12-24 hours 5
- Haemophilus influenzae (β-lactamase producing): 50-100 mg/kg/day every 12-24 hours 5
- Gram-negative enteric bacilli: 100 mg/kg/day divided every 12 hours or 80 mg/kg/day every 24 hours (up to 4 g daily) 1
Special Clinical Situations
Gonococcal conjunctivitis in children ≤45 kg: 25-50 mg/kg IV or IM as a single dose, not to exceed 250 mg IM 1
Bacteremia or arthritis: 50 mg/kg/day given daily for 7 days 1
Pharmacokinetic Support
The FDA label confirms that after a 50 mg/kg IV dose in pediatric meningitis patients, maximum plasma concentrations reach 216 mcg/mL with CSF concentrations of 5.6 mcg/mL (range 1.3-18.5), and after 75 mg/kg, plasma levels reach 275 mcg/mL with CSF concentrations of 6.4 mcg/mL. 6 The elimination half-life in pediatric patients is approximately 4.3-4.6 hours. 6
Clinical Efficacy Data
Multiple studies demonstrate excellent clinical cure rates of 94-97% using once-daily dosing regimens of 50-80 mg/kg for serious pediatric infections including meningitis, with minimal adverse effects (10% experiencing any side effects, none requiring discontinuation). 7, 4 The convenience of once-daily dosing has enabled successful outpatient treatment of serious infections that traditionally required hospitalization. 3