What is the recommended dose of ceftriaxone (Ceftriaxone) for a 4-year-old child weighing 23.2 kg?

Ceftriaxone Dosing for a 4-Year-Old Child Weighing 23.2 kg

For this 4-year-old child weighing 23.2 kg, administer ceftriaxone 50-75 mg/kg/day (1,160-1,740 mg/day) given once daily or divided every 12 hours, with the specific dose depending on infection severity and type.

Standard Pediatric Dosing Framework

The dosing for this child follows a severity-based algorithm:

For Less Severe Infections

• Administer 50-75 mg/kg/day (1,160-1,740 mg for this 23.2 kg child) given once daily or divided every 12-24 hours 1
• This range applies to skin and soft tissue infections, uncomplicated pneumonia, and most common bacterial infections 1, 2
• The FDA label confirms 50-75 mg/kg as the standard pediatric dose for skin/soft tissue infections and serious miscellaneous infections other than meningitis 2

For Severe Infections

• Administer 50-100 mg/kg/day (1,160-2,320 mg for this child) given once daily or divided every 12-24 hours 1
• This higher range is appropriate for severe pneumonia, sepsis, complicated intra-abdominal infections, and bacteremia 1
• For community-acquired pneumonia specifically, use 50-100 mg/kg/day 1

For Meningitis

• Administer 100 mg/kg/day (2,320 mg for this child) divided every 12-24 hours, with a maximum of 4 grams daily 1, 2
• The FDA label specifies an initial therapeutic dose of 100 mg/kg (not to exceed 4 grams), followed by 100 mg/kg/day for the duration of therapy 2

Critical Dosing Considerations

Maximum Daily Dose

• Never exceed 2 grams daily for non-meningitis infections in this child 2
• For meningitis, the maximum is 4 grams daily 1, 2
• Pediatric doses should not exceed adult doses even when weight-based calculations suggest higher amounts 1

Administration Route and Timing

• Intravenous doses should be administered over 30 minutes in children (60 minutes in neonates only) 2
• Once-daily dosing is effective for most infections due to ceftriaxone's long half-life of 6-8 hours 3, 4
• Divided dosing every 12 hours may be preferred for severe infections or meningitis to maintain consistent drug levels 1

Practical Dosing Examples for This 23.2 kg Child

Mild-Moderate Infection (e.g., uncomplicated pneumonia, skin infection)

• 1,160 mg (50 mg/kg) once daily OR
• 580 mg (25 mg/kg) every 12 hours 1, 2

Severe Infection (e.g., severe pneumonia, sepsis)

• 2,000 mg (86 mg/kg) once daily OR
• 1,000 mg (43 mg/kg) every 12 hours 1

Meningitis

• 2,320 mg (100 mg/kg) divided as 1,160 mg every 12 hours 1, 2

Common Pitfalls to Avoid

• Do not use the lower end of dosing (50 mg/kg/day) for severe sepsis or life-threatening infections—this underdoses the patient and may lead to treatment failure 1
• Do not exceed 2 grams daily for non-CNS infections in this weight range, as pediatric doses should not surpass adult dosing 1, 2
• Do not administer as IV push—always infuse over 30 minutes to reduce adverse effects 2
• Do not mix with calcium-containing solutions at any point during administration, as precipitation can occur 2

Duration of Therapy

• Continue therapy for at least 2 days after signs and symptoms of infection have disappeared 2
• Usual duration is 4-14 days depending on infection type and severity 2
• For streptococcal infections, continue for at least 10 days 2