What is the dose of ceftriaxone (Ceftriaxone is a third-generation cephalosporin antibiotic)?

From the Guidelines

The recommended dose of ceftriaxone for adults with community-acquired bacterial meningitis is 2 grams every 12 hours, as stated in the ESCMID guideline 1. For children, the dose is 50-100 mg/kg/day, not exceeding the adult maximum. When treating other severe infections, doses up to 4 grams daily (divided into two doses) may be used. For gonorrhea, a single 500 mg intramuscular dose is often sufficient. Duration of treatment varies by infection type, typically ranging from a single dose for gonorrhea to 10-14 days for more serious infections. Ceftriaxone should be adjusted in patients with severe renal and hepatic impairment when used together. This third-generation cephalosporin works by inhibiting bacterial cell wall synthesis and is effective against many gram-positive and gram-negative bacteria, making it valuable for treating various infections including pneumonia, meningitis, intra-abdominal infections, and sexually transmitted infections. The dose of ceftriaxone may vary depending on the specific infection being treated, as outlined in other guidelines such as those for infective endocarditis 1. However, for community-acquired bacterial meningitis, the dose recommended by the ESCMID guideline 1 is the most relevant and should be prioritized to ensure optimal treatment outcomes and minimize morbidity and mortality. Key considerations in ceftriaxone dosing include:

• Patient age and weight
• Type and severity of infection
• Renal and hepatic function
• Potential interactions with other medications
• Local resistance patterns and susceptibility testing results, as available. Given the potential for severe consequences of untreated or inadequately treated bacterial meningitis, it is crucial to follow established guidelines and consult with infectious disease specialists when necessary to ensure the best possible outcomes for patients 1.

From the FDA Drug Label

Average plasma concentrations of ceftriaxone following a single 30-minute intravenous (IV) infusion of a 0.5,1 or 2 gram dose Multiple IV or IM doses ranging from 0.5 to 2 grams at 12- to 24-hour intervals The preoperative administration of a single 1 gram dose of Ceftriaxone for Injection may reduce the incidence of postoperative infections Although Ceftriaxone for Injection has been shown to have been as effective as cefazolin in the prevention of infection following coronary artery bypass surgery, no placebo-controlled trials have been conducted to evaluate any cephalosporin antibiotic in the prevention of infection following coronary artery bypass surgery When administered prior to surgical procedures for which it is indicated, a single 1 gram dose of Ceftriaxone for Injection provides protection from most infections due to susceptible organisms throughout the course of the procedure.

The dose of ceftriaxone can range from 0.5 grams to 2 grams, and it can be administered through IV or IM routes. A single dose of 1 gram is often used for surgical prophylaxis, and it provides protection throughout the course of the procedure 2 2.

• The dose may be repeated every 12 to 24 hours.
• The specific dose and frequency may depend on the indication and patient population.
• It is essential to consult the FDA drug label for specific dosing recommendations for each indication.

From the Research

Ceftriaxone Dosing

• The optimal dose of ceftriaxone for treating bacteremia is not well established, with studies suggesting both 1g and 2g daily doses may be effective 3.
• A retrospective analysis of 128 patients with bacteremia found no significant difference in clinical failure rates between those receiving 1g or 2g of ceftriaxone daily 3.
• However, a pharmacokinetic study suggested that a 2g once-daily dose of ceftriaxone may be necessary to achieve therapeutic exposure in patients with sepsis and a creatinine clearance ≤ 140 mL/min 4.

Specific Patient Populations

• In patients with liver cirrhosis, the pharmacokinetics of ceftriaxone may be altered, with increased unbound concentrations mitigated by increased renal clearance 5.
• For patients with bacterial meningitis, ceftriaxone has been compared to other antibiotics such as meropenem, with meropenem showing effective and well-tolerated results 6, 7.

Comparison to Other Antibiotics

• Meropenem has been shown to be an effective alternative to ceftriaxone for the treatment of bacterial meningitis, with comparable bactericidal activity 6, 7.
• The combination of ceftriaxone with vancomycin has not been shown to be synergistic against cephalosporin-resistant Streptococcus pneumoniae 7.