What is the recommended dose for ceftriaxone (Ceftriaxone)?

Ceftriaxone Dosing Recommendations

The standard adult dose of ceftriaxone is 1-2 grams given once daily (or divided twice daily) for most infections, with specific dosing determined by infection type and severity. 1, 2

Adult Dosing by Indication

Uncomplicated Gonococcal Infections

• Single dose of 125-250 mg IM for uncomplicated cervical, urethral, or rectal infections 3, 1
• Must add treatment for chlamydia if not ruled out 3

Disseminated Gonococcal Infection (DGI)

• 1 gram IM or IV every 24 hours initially 3, 4
• Continue for 24-48 hours after clinical improvement begins, then switch to oral therapy to complete one week total 4

Central Nervous System Infections

• 2 grams IV every 12 hours for bacterial meningitis (total 4 grams daily) 4
• Duration: 10-14 days for pneumococcal or gonococcal meningitis 3, 4
• Duration: 5 days for meningococcal meningitis 4
• Duration: 21 days for Enterobacteriaceae CNS infections 4
• For patients ≥60 years, add amoxicillin 2 grams IV every 4 hours to cover Listeria monocytogenes 4
• For penicillin-resistant pneumococci, add vancomycin 15-20 mg/kg IV twice daily or rifampicin 600 mg twice daily 4

Gonococcal Endocarditis

• 1-2 grams IV every 12 hours for at least 4 weeks 3, 4

Gonococcal Conjunctivitis

• Single dose of 1 gram IM with consideration of saline lavage 3, 4

Community-Acquired Pneumonia and Skin/Soft Tissue Infections

• 1-2 grams once daily depending on severity 1, 2
• Evidence shows 1 gram daily is as effective as 2 grams daily for community-acquired pneumonia 5

Surgical Prophylaxis

• Single dose of 1 gram IV administered 30 minutes to 2 hours before surgery 1, 2

Pediatric Dosing

Neonates (≤28 days)

• Contraindicated in hyperbilirubinemic neonates and those requiring calcium-containing IV solutions 1, 2
• 25-50 mg/kg/day IV or IM once daily for gonococcal infections (7 days; 10-14 days if meningitis) 4
• IV doses must be given over 60 minutes to reduce risk of bilirubin encephalopathy 1, 2

Infants and Children

• 50-75 mg/kg once daily (maximum 2 grams) for skin/soft tissue infections 1, 2
• 50 mg/kg IM single dose (maximum 1 gram) for acute otitis media 1, 2
• 50-75 mg/kg divided every 12 hours (maximum 2 grams daily) for serious non-CNS infections 1, 2
• Initial dose 100 mg/kg (maximum 4 grams), then 100 mg/kg/day (maximum 4 grams daily) once daily or divided every 12 hours for meningitis 1, 2
• Duration: 7-14 days for meningitis 1, 2
• Children ≥45 kg should use adult dosing 4

Critical Dosing Considerations

Maximum Daily Dose

• Total daily dose should not exceed 4 grams in adults 1, 2

Renal/Hepatic Impairment

• No dosage adjustment necessary unless both severe renal and hepatic impairment are present 1, 2

Elderly Patients

• No modification required up to 2 grams per day if no severe renal/hepatic impairment 1, 2

Duration of Therapy

• Continue for at least 2 days after signs/symptoms resolve 1, 2
• Usual duration: 4-14 days for most infections 1, 2
• At least 10 days for Streptococcus pyogenes infections 1, 2

Administration Guidelines

Intravenous

• Administer over 30 minutes in adults 1, 2
• Administer over 60 minutes in neonates to reduce bilirubin encephalopathy risk 1, 2
• Recommended concentrations: 10-40 mg/mL 1, 2

Intramuscular

• Inject deep into large muscle mass with aspiration to avoid vascular injection 1, 2
• Reconstitute to 250 mg/mL or 350 mg/mL concentration 1

Common Pitfalls to Avoid

Calcium-Containing Solutions

• Never mix with or administer simultaneously via Y-site with calcium-containing solutions due to precipitation risk 1, 2
• In patients >28 days old, may administer sequentially if lines thoroughly flushed between infusions 1, 2

Inadequate Dosing for Resistant Organisms

• Treatment failures reported with 250-500 mg doses, particularly for pharyngeal gonococcal infections with elevated MICs 4
• For ceftriaxone-resistant strains, twice-daily dosing of 2 grams may be required 4

CNS Infections Requiring Twice-Daily Dosing

• Twice-daily dosing (2 grams every 12 hours) is essential for meningitis to maintain adequate CSF concentrations 4
• Once-daily dosing is insufficient for CNS infections despite adequacy for other indications 4

Missing Chlamydia Coverage

• Always add antichlamydial coverage for gonococcal infections if chlamydia not ruled out 3, 1, 2