Recommended Ceftriaxone Dose for a 5-Year-Old with Pneumonia
For a 5-year-old child weighing 54 lbs (24.5 kg) with community-acquired pneumonia, administer ceftriaxone 50 mg/kg once daily, which equals approximately 1,225 mg (1.2 grams) daily, given intravenously or intramuscularly. 1, 2, 3
Dosing Calculation and Administration
- Weight-based calculation: 54 lbs = 24.5 kg × 50 mg/kg = 1,225 mg daily 2, 3
- Route of administration: Can be given either intravenously over 30 minutes or intramuscularly 3
- Frequency: Once daily dosing is appropriate and well-established for pediatric pneumonia 1, 2, 4, 5
- Maximum dose consideration: The calculated dose of 1.2 grams is well below the 2-gram daily maximum for non-meningitis infections in children 3
Clinical Context from Guidelines
The 2011 PIDS/IDSA guidelines for pediatric community-acquired pneumonia recommend ceftriaxone or cefotaxime as alternatives to ampicillin/penicillin for hospitalized children, particularly when the child is not fully immunized or when local penicillin resistance is significant 1. For a 5-year-old requiring hospitalization, ceftriaxone serves as an appropriate empiric choice for presumed bacterial pneumonia 1.
Dosing Range Considerations
- Standard range: 50-75 mg/kg/day for serious infections including pneumonia 2, 3
- For this patient: Starting at 50 mg/kg (1,225 mg) is appropriate for typical community-acquired pneumonia 1, 2
- Higher dosing (75-100 mg/kg/day): Reserved for severe infections, suspected resistant organisms, or meningitis 2, 3
Duration of Therapy
- Typical course: 7-10 days for uncomplicated pneumonia 1
- Clinical improvement: Should be evident within 48-72 hours; if not, further investigation is warranted 1
- Outpatient transition: After 48 hours of clinical stability, consider transitioning to outpatient therapy with continued once-daily ceftriaxone 4, 5
Important Clinical Caveats
If MRSA is suspected (necrotizing pneumonia, severe illness, post-influenza), add vancomycin or clindamycin, as ceftriaxone has no activity against methicillin-resistant organisms 1, 6. The evidence shows poor outcomes when ceftriaxone is used alone for MSSA pneumonia at lower doses, though this primarily applies to the 1 gram daily adult dosing 6.
If atypical pneumonia cannot be excluded (school-age child with gradual onset, no consolidation), add azithromycin to the ceftriaxone regimen 1.
Avoid calcium-containing solutions when reconstituting or administering ceftriaxone, as particulate formation can occur 3.
Practical Administration
For intramuscular administration: Reconstitute the vial to achieve 250-350 mg/mL concentration and inject 3.5-4.9 mL (depending on concentration) deep into a large muscle mass 3.
For intravenous administration: Reconstitute to 100 mg/mL and infuse over 30 minutes; concentrations between 10-40 mg/mL are acceptable 3.