What is the recommended dosage of Rocephine (ceftriaxone) for pediatric patients?

Rocephin (Ceftriaxone) Pediatric Dosing

For most serious pediatric infections, ceftriaxone should be dosed at 50-75 mg/kg/day given once daily or divided every 12 hours, with meningitis requiring 100 mg/kg/day, and the maximum daily dose not exceeding 4 grams. 1

Neonatal Dosing (Age-Specific)

• Neonates ≤7 days old: 50 mg/kg/day given every 24 hours 2
• Neonates >7 days and ≤2000 g: 50 mg/kg/day given every 24 hours 2
• Neonates >7 days and >2000 g: 50-75 mg/kg/day given every 24 hours 2
• Critical contraindication: Do not use ceftriaxone in hyperbilirubinemic neonates 2
• Administration requirement: Intravenous doses must be given over 60 minutes in neonates to reduce the risk of bilirubin encephalopathy 1

Standard Pediatric Dosing by Infection Severity

Meningitis

• Initial dose: 100 mg/kg (not to exceed 4 grams) 1
• Maintenance: 100 mg/kg/day (maximum 4 g daily) given once daily or divided every 12 hours 2, 1
• Duration: 7-14 days typically 1

Severe Infections (Pneumonia, Sepsis, Complicated Intra-abdominal Infections)

• Dose: 50-100 mg/kg/day given once daily or divided every 12-24 hours 2
• Maximum: 2-4 grams daily depending on severity 1
• For pneumococcal pneumonia with penicillin resistance (MIC ≥4.0 μg/mL), use 100 mg/kg/day 2, 3

Less Severe Infections (Skin/Soft Tissue)

• Dose: 50-75 mg/kg/day given once daily or divided twice daily 2, 1
• Maximum: 2 grams daily 1

Acute Otitis Media

• Single intramuscular dose: 50 mg/kg (not to exceed 1 gram) 1

Specific Pathogen Considerations

Gonococcal Infections

• Uncomplicated infections (patients <45 kg): 125 mg IM single dose 2
• Gonococcal conjunctivitis: 25-50 mg/kg IV or IM single dose (not to exceed 250 mg) 2
• Bacteremia or arthritis: 50 mg/kg/day for 7 days 2

Endocarditis

• HACEK organisms: 100 mg/kg/day IV/IM once daily for 4 weeks (native valve) or 6 weeks (prosthetic valve) 2
• Streptococcal endocarditis: 100 mg/kg/day divided every 12 hours or 80 mg/kg/day every 24 hours (maximum 4 g daily) 2

Gram-Negative Enteric Bacilli

• Dose: 100 mg/kg/day divided every 12 hours OR 80 mg/kg/day every 24 hours (maximum 4 g daily) 2

Administration Considerations

Route and Timing

• Intravenous infusion: Administer over 30 minutes in children, 60 minutes in neonates 1
• Intramuscular injection: Can be used but is painful; counsel patients accordingly 2
• Once-daily dosing: Provides equal efficacy to divided dosing with greater convenience 4

Duration of Therapy

• General rule: Continue for at least 2 days after signs and symptoms resolve 1
• Streptococcus pyogenes infections: Minimum 10 days 1
• Complicated infections: May require longer than 14 days 1

Critical Safety Considerations

Contraindications and Warnings

• Never use calcium-containing diluents (Ringer's solution, Hartmann's solution) as particulate formation can result 1
• Avoid in hyperbilirubinemic neonates due to risk of kernicterus 2
• Monitor for neutropenia: Rare but may require discontinuation 4

Drug Incompatibilities

• Do not physically mix with vancomycin, amsacrine, aminoglycosides, or fluconazole 1
• If co-administration needed, give sequentially with thorough line flushing 1

Maximum Dose Limitations

• Pediatric doses should never exceed adult doses: Maximum 4 grams daily regardless of weight-based calculation 2, 1