What is the recommended intravenous (IV) dosage of Ceftriaxone (Ceftriaxone) for treating infections?

Ceftriaxone IV Dosing Recommendations

For most adult infections, ceftriaxone should be dosed at 1-2 grams IV once daily, with higher doses (2 grams every 12 hours) reserved specifically for central nervous system infections including meningitis and endocarditis. 1

Standard Adult Dosing by Infection Type

General Infections

• 1-2 grams IV once daily is the standard adult dose for most infections, with the specific amount determined by infection severity 1
• The total daily dose should not exceed 4 grams 1
• For skin and soft tissue infections, 1 gram every 12-24 hours is appropriate depending on severity 2

CNS Infections (Meningitis, Endocarditis)

• 2 grams IV every 12 hours (total 4 grams daily) is required for bacterial meningitis 2
• For pneumococcal meningitis: 2 grams IV every 12 hours for 10-14 days 2
• For meningococcal meningitis: 2 grams IV every 12 hours for 5 days 2
• For gonococcal meningitis: 1-2 grams IV every 12 hours for 10-14 days 3
• For gonococcal endocarditis: 1-2 grams IV every 12 hours for at least 4 weeks 3

Twice-daily dosing is essential for CNS infections to maintain adequate cerebrospinal fluid concentrations throughout the dosing interval. 2

Gonococcal Infections

• Disseminated gonococcal infection (DGI): 1 gram IM or IV every 24 hours, continued for 24-48 hours after clinical improvement, then switch to oral therapy to complete one week total 3, 2
• Gonococcal conjunctivitis: 1 gram IM single dose with consideration of saline eye lavage 3
• Uncomplicated gonococcal infections: 250 mg IM single dose (though this is IM, not IV) 1

Endocarditis (Non-Gonococcal)

• HACEK organisms: 2 grams IV/IM once daily for 4 weeks (6 weeks for prosthetic valve) 2
• Highly penicillin-susceptible viridans streptococci: 2 grams IV/IM once daily for 4 weeks as monotherapy 2

Pediatric Dosing

General Pediatric Infections

• 50-75 mg/kg once daily (or divided every 12 hours) for skin/soft tissue infections, not to exceed 2 grams total daily dose 1
• 50-75 mg/kg in divided doses every 12 hours for serious miscellaneous infections (non-meningitis), not to exceed 2 grams daily 1

Pediatric Meningitis

• Initial dose: 100 mg/kg (not to exceed 4 grams) 1
• Maintenance: 100 mg/kg/day (not to exceed 4 grams daily), given once daily or divided every 12 hours 1
• Duration: 7-14 days typically 1

Neonatal Gonococcal Infections

• 25-50 mg/kg/day IV or IM as single daily dose for 7 days (10-14 days if meningitis documented) 2

Administration Guidelines

IV Infusion Timing

• Standard IV administration: Infuse over 30 minutes 1
• Neonates: Infuse over 60 minutes to reduce risk of bilirubin encephalopathy 1
• Recommended concentrations: 10-40 mg/mL, though lower concentrations may be used 1

Duration of Therapy

• Continue for at least 2 days after signs and symptoms of infection have disappeared 1
• Usual duration: 4-14 days depending on infection type 1
• For Streptococcus pyogenes infections: Continue for at least 10 days 1

Special Populations and Considerations

Renal/Hepatic Impairment

• No dosage adjustment necessary for renal or hepatic impairment up to 2 grams per day 1
• This applies to elderly patients as well, provided there is no severe renal and hepatic impairment 1

Resistant Organisms

• For pharyngeal gonorrhea with elevated MICs, treatment failures have occurred with 250-500 mg doses 2
• Higher doses or twice-daily dosing of 2 grams may be required for resistant strains to achieve adequate free plasma concentrations 2

Adjunctive Therapy Considerations

• For penicillin-resistant pneumococci in meningitis, add vancomycin 15-20 mg/kg IV or rifampicin 600 mg twice daily 2
• For patients ≥60 years with suspected meningitis, add amoxicillin 2 grams IV every 4 hours to cover Listeria monocytogenes 2
• If Chlamydia trachomatis is suspected, add appropriate antichlamydial coverage as ceftriaxone has no activity against this organism 1

Critical Pitfalls to Avoid

• Do not use once-daily dosing for meningitis or endocarditis - these infections require every 12-hour dosing to maintain therapeutic CSF/tissue levels 2
• Do not use diluents containing calcium (Ringer's solution, Hartmann's solution) as particulate formation can result 1
• Do not physically mix with aminoglycosides, vancomycin, amsacrine, or fluconazole - these are incompatible in admixtures 1
• For lower MIC organisms (≤2 mg/L), standard dosing achieves adequate target attainment, but for MIC ≥4 mg/L, particularly with normal/high renal function, standard once-daily dosing may be insufficient 4