What is the dosage and treatment duration of ceftriaxone (Ceftriaxone) for a 10-year-old female patient with community-acquired pneumonia or urinary tract infection?

Ceftriaxone Dosing for a 10-Year-Old Female Patient

For community-acquired pneumonia in a 10-year-old, administer ceftriaxone 50-100 mg/kg/day intravenously, divided every 12-24 hours, not exceeding 2 grams daily for typical pathogens or 4 grams daily for meningitis. 1, 2

Indication-Specific Dosing

Community-Acquired Pneumonia

For typical bacterial pneumonia (Streptococcus pneumoniae, Haemophilus influenzae):

• Dose: 50-100 mg/kg/day IV, divided every 12-24 hours 1
• Maximum daily dose: 2 grams 2
• Duration: 7-14 days, or at least 2 days after clinical improvement 2
• Ceftriaxone is the preferred agent for β-lactamase producing H. influenzae 1

For severe pneumonia or suspected resistant organisms:

• Dose: 100 mg/kg/day IV (same as meningitis dosing for CNS-penetrating coverage) 1
• Maximum: 4 grams daily 2

Administration considerations:

• Infuse over 30 minutes in children (60 minutes only required for neonates) 2
• Can be given once daily or divided into twice-daily dosing 1, 2

Urinary Tract Infections

For complicated UTI or pyelonephritis:

• Dose: 50-75 mg/kg/day IV once daily 2, 3
• Maximum: 2 grams daily 2
• Duration: 7-10 days 3
• Clinical improvement typically seen within 48-72 hours 4

Pathogen-Specific Considerations

Streptococcus pneumoniae (including penicillin-resistant strains):

• Ceftriaxone 100 mg/kg/day is preferred for hospitalized patients 1
• Alternative to ampicillin 300-400 mg/kg/day 1

Group A Streptococcus:

• Ceftriaxone 50-100 mg/kg/day is an alternative (not first-line) 1
• Penicillin or ampicillin remain preferred agents 1

Haemophilus influenzae (β-lactamase producing):

• Ceftriaxone 50-100 mg/kg/day is the preferred parenteral agent 1

Important Safety Considerations

Contraindications in this age group:

• Do not use calcium-containing IV solutions simultaneously 2
• Flush IV lines thoroughly between ceftriaxone and calcium-containing solutions 2
• No dosage adjustment needed for renal or hepatic impairment 2

Common pitfalls to avoid:

• Do not exceed 2 grams daily for routine infections (skin, soft tissue, pneumonia, UTI) 2
• Reserve 4-gram maximum only for meningitis 2
• Ensure therapy continues at least 10 days for Group A Streptococcus to prevent rheumatic fever 2
• For atypical pathogens (Mycoplasma, Chlamydia), add macrolide coverage as ceftriaxone has no activity 1, 2

Practical Dosing Example

For a 10-year-old weighing 30 kg with community-acquired pneumonia:

• Standard dose: 1,500-3,000 mg/day (50-100 mg/kg/day) 1
• Practical regimen: 1,500 mg IV once daily or 750 mg IV every 12 hours 1, 2
• Maximum not to exceed: 2,000 mg/day for pneumonia 2