What is the youngest age to administer ceftriaxone (Ceftriaxone is a generic name, it's a third-generation cephalosporin antibiotic)?

From the Guidelines

Ceftriaxone can be administered to infants as young as 29 days old.

Administration Guidelines

• According to the American Academy of Pediatrics, ceftriaxone is recommended for infants 29 to 90 days of age without signs of meningitis or severe illness 1.
• The dosage for ceftriaxone in infants 29 to 60 days old is 50 mg/kg per dose every 24 hours for urinary tract infections or when no focus of infection is identified 1.
• For infants with bacterial meningitis, ceftriaxone can be administered at a dose of 100 mg/kg per day once daily or divided every 12 hours 1.

Important Considerations

• The use of ceftriaxone in infants younger than 29 days old is not recommended due to the potential risk of interactions with calcium-containing products 1.
• It is essential to consult local antibiograms to guide antibiotic choices and ensure appropriate coverage for suspected pathogens 1.
• Ceftriaxone is a third-generation cephalosporin antibiotic and should be used judiciously to minimize the risk of antibiotic resistance 1.
• The WHO recommends ceftriaxone as a second-choice antibiotic for sepsis in children, to be used in certain cases 1.

From the FDA Drug Label

Ceftriaxone for injection is contraindicated in premature neonates up to a postmenstrual age of 41 weeks (gestational age + chronological age). Ceftriaxone for injection is contraindicated in neonates (≤ 28 days) if they require (or are expected to require) treatment with calcium-containing IV solutions, including continuous calcium- containing infusions such as parenteral nutrition because of the risk of precipitation of ceftriaxone-calcium For the treatment of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses twice a day). For the treatment of acute bacterial otitis media, a single intramuscular dose of 50 mg/kg (not to exceed 1 gram) is recommended

The youngest age to administer ceftriaxone is more than 28 days for full-term neonates not requiring calcium-containing IV solutions, but the exact age in weeks for premature neonates is postmenstrual age of more than 41 weeks 2 2.

From the Research

Administration of Ceftriaxone in Young Patients

• The youngest age to administer ceftriaxone can be inferred from several studies, including one from 3 where ceftriaxone was administered to newborn and young infants, with ages ranging from 0 to 106 days.
• In the study by 3, dose levels were 15 to 23 mg/kg every 12 to 24 hours for 2 to 13.5 days, and the drug was well tolerated, although some side effects were observed.
• Another study by 4 investigated the population pharmacokinetics of ceftriaxone in infants and suggested regimens of 20 mg/kg of body weight twice daily for infants under 1 year of age.
• The study by 5 also provided dosing recommendations for ceftriaxone in children with severe acute malnutrition, suggesting 80 mg/kg once daily.

Key Findings

• Ceftriaxone can be administered to infants as young as a few days old, as seen in the study by 3.
• The appropriate dosage of ceftriaxone varies by age and weight, with studies by 4 and 5 providing specific recommendations.
• Ceftriaxone is generally well tolerated in young patients, although side effects can occur, as noted in the study by 3.
• The pharmacokinetics of ceftriaxone in infants and children have been studied, with findings informing optimal dosing regimens, as seen in the studies by 4 and 5.