What is the recommended dose of Rocephin (Ceftriaxone) for treating cellulitis?

Ceftriaxone Dosing for Cellulitis

For moderate-to-severe cellulitis in adults, administer ceftriaxone 1 gram IV or IM once daily, which has been proven effective in randomized controlled trials and is supported by FDA labeling for skin and soft tissue infections. 1, 2

Standard Dosing Regimen

• Adults: The FDA-approved dose for skin and soft tissue infections is 1-2 grams once daily (or divided twice daily), with a maximum of 4 grams per day 1
• Once-daily dosing of 1 gram is clinically equivalent to more frequent dosing regimens and provides the convenience of outpatient parenteral therapy 2, 3, 4
• The typical treatment duration is 4-14 days, continuing for at least 2 days after signs and symptoms resolve 1

Pediatric Dosing

• Children: 50-75 mg/kg once daily (or divided every 12 hours), not exceeding 2 grams total daily dose 1
• Once-daily dosing at 50 mg/kg has demonstrated 96% clinical cure rates in pediatric cellulitis 5
• For neonates, dosing varies by age and weight, with special caution in hyperbilirubinemic infants 1

Administration Considerations

• IV administration: Infuse over 30 minutes in adults (60 minutes in neonates) at concentrations of 10-40 mg/mL 1
• IM administration: Reconstitute to 250 mg/mL or 350 mg/mL and inject into a large muscle mass 1
• Both routes are equally effective for cellulitis treatment 2, 3

Evidence Quality

The recommendation for 1 gram once daily is based on:

• Multiple randomized controlled trials demonstrating 81-96% clinical cure rates 2, 4
• FDA approval specifically for skin and soft tissue infections 1
• Superior convenience for home-based therapy without compromising efficacy 2, 3

Common Pitfalls to Avoid

• Do not use doses lower than 1 gram daily for moderate-to-severe cellulitis in adults, as the evidence base supports 1-2 grams 1, 2, 4
• Avoid calcium-containing diluents (Ringer's solution, Hartmann's solution) due to precipitation risk 1
• Do not mix with aminoglycosides or vancomycin in the same infusion; flush lines between administrations 1
• For polymicrobial infections, ceftriaxone shows superior efficacy compared to narrower-spectrum agents 4

When to Consider Higher Dosing

Higher doses (2 grams daily or divided dosing) are NOT typically required for uncomplicated cellulitis but may be considered for:

• Severe infections with systemic toxicity 1
• Immunocompromised patients 1
• Infections with documented resistant organisms 6