Ceftriaxone Dosing for Pediatric UTI
For a pediatric patient with suspected urinary tract infection, administer ceftriaxone 50-75 mg/kg/day given once daily or divided every 12-24 hours, with a maximum dose of 4 grams daily. 1
Standard Dosing Recommendations
The American Academy of Pediatrics provides clear guidance for ceftriaxone dosing in pediatric infections:
- For less severe infections (including uncomplicated UTI): 50-75 mg/kg/day given once daily or divided every 12-24 hours 1
- For severe infections: 50-100 mg/kg/day given once daily or divided every 12-24 hours 1
- Maximum daily dose: Should not exceed 4 grams regardless of weight 1
Age-Specific Considerations
Neonatal dosing differs significantly and requires careful attention:
- Neonates ≤7 days postnatal age: 50 mg/kg/day every 24 hours 1
- Neonates >7 days and ≤2000 g: 50 mg/kg/day every 24 hours 1
- Neonates >7 days and >2000 g: 50-75 mg/kg/day every 24 hours 1
- Critical caveat: Ceftriaxone should NOT be used in hyperbilirubinemic neonates due to risk of kernicterus 1
Practical Dosing Example
For a typical pediatric patient (e.g., 20 kg child) with suspected UTI:
- Standard dose: 1000-1500 mg (50-75 mg/kg) once daily 1
- Route: Can be given intravenously or intramuscularly, though IM injection is painful and patients should be counseled accordingly 1
Clinical Efficacy Evidence
Research supports once-daily ceftriaxone for UTI treatment:
- Once-daily ceftriaxone demonstrated superior bacteriologic eradication compared to cefazolin given three times daily in complicated and uncomplicated UTIs 2
- A 3-day course of ceftriaxone was as efficacious as longer antibiotic courses for uncomplicated UTI in hospitalized patients 3
- Single-dose ceftriaxone combined with oral antibiotics showed no additional benefit over oral therapy alone in febrile children with UTI, suggesting that if ceftriaxone is used, it should be part of a complete treatment course rather than a single dose 4
Important Clinical Caveats
When ceftriaxone is particularly useful:
- Child unable to tolerate oral medications or vomiting 5
- Concern for non-adherence to oral therapy 5
- Failed initial oral antibiotic therapy after 72 hours 5
Treatment strategy: If using ceftriaxone for UTI and clinical improvement occurs within 24 hours, consider transitioning to oral antibiotics to complete the treatment course 5