What is the recommended dose of ceftriaxone (Ceftriaxone) for treating urinary tract infections (UTIs)?

Ceftriaxone Dosing for UTIs

For uncomplicated pyelonephritis, administer ceftriaxone 1 gram IV/IM as a single dose when initiating therapy with oral antibiotics, particularly when fluoroquinolone resistance exceeds 10% or when using less effective oral agents like trimethoprim-sulfamethoxazole or beta-lactams. 1

Dosing by Clinical Scenario

Uncomplicated Pyelonephritis (Outpatient)

• Standard dose: 1 gram IV/IM once as initial therapy before transitioning to oral antibiotics 1
• This single dose is recommended when:
  • Fluoroquinolone resistance in your community exceeds 10% 1
  • Using oral trimethoprim-sulfamethoxazole empirically (susceptibility unknown) 1
  • Using oral beta-lactam agents (which are less effective than fluoroquinolones) 1

Uncomplicated Pyelonephritis (Hospitalized Patients)

• Dose: 1-2 grams IV once daily 1
• The European Association of Urology (2024) notes that while 1 gram was studied, 2 grams daily is the recommended dose for hospitalized patients 1
• Continue until patient can transition to oral therapy based on clinical improvement and susceptibility results 1

Complicated UTIs

• Dose: 1-2 grams IV once daily 2, 3, 4
• Studies demonstrate efficacy with 1 gram daily for 5-10 days in complicated infections 2, 5, 3
• The once-daily dosing is particularly advantageous in seriously ill or elderly patients 6

Key Clinical Considerations

Route of administration: Ceftriaxone can be given IV or IM; the IM route is acceptable when IV access is unavailable, though data supporting this approach are limited 1

Duration considerations:

• For outpatient pyelonephritis: Single dose followed by 7-14 days of oral therapy depending on the oral agent chosen 1
• For hospitalized pyelonephritis: Continue until clinical improvement allows oral transition 1
• For complicated UTIs: 5-10 days of therapy 2, 5, 3

Important caveats:

• Always obtain urine culture and susceptibility testing before initiating therapy for pyelonephritis 1
• Tailor therapy based on culture results once available 1
• In patients with chronic renal failure, ceftriaxone achieves very high serum levels and is not removed by standard hemodialysis 5

Resistance patterns matter: The decision to use ceftriaxone as initial therapy hinges on local fluoroquinolone resistance rates—if resistance is ≤10%, fluoroquinolones alone may be used without ceftriaxone 1

Not for simple cystitis: Ceftriaxone is not recommended for uncomplicated cystitis (lower UTI), where oral agents are preferred 1