What is the recommended dose of Ceftriaxone (Ceftriaxone) for a 1-year-old patient with suspected or confirmed meningitis?

Ceftriaxone Meningitic Dose for a 1-Year-Old

For a 1-year-old child with suspected or confirmed bacterial meningitis, administer ceftriaxone 100 mg/kg/day intravenously, which can be given as a single daily dose or divided into 50 mg/kg every 12 hours, with a maximum daily dose of 4 grams. 1

Dosing Algorithm

Initial Therapeutic Dose

• Start with 100 mg/kg as the initial loading dose (not to exceed 4 grams) 1
• Continue with 100 mg/kg/day as the total daily maintenance dose (maximum 4 grams daily) 1

Frequency Options

You have two evidence-based approaches:

Option 1: Once-Daily Dosing (Preferred)

• Administer 100 mg/kg as a single daily dose 2, 1
• This regimen achieves superior CSF penetration with 88% probability of target attainment at 24 hours compared to 53% with twice-daily dosing 3
• CSF concentrations remain 10-100 fold higher than the MIC of common pathogens throughout the 24-hour dosing interval 4

Option 2: Twice-Daily Dosing

• Administer 50 mg/kg every 12 hours 2, 1
• This approach is equally effective but requires more frequent administration 5

Administration Details

• Infusion time: 30 minutes for children over 28 days of age 1
• Reconstitute to concentrations between 10-40 mg/mL for IV administration 1
• Do NOT use calcium-containing diluents (Ringer's solution, Hartmann's solution) due to precipitation risk 1

Duration of Therapy

The treatment duration depends on the identified pathogen:

• Meningococcal meningitis (N. meningitidis): 5-7 days if clinically recovered 6, 7
• Pneumococcal meningitis (S. pneumoniae): 10-14 days, with longer duration if delayed clinical response 6
• H. influenzae meningitis: 10 days 6
• Culture-negative meningitis: Continue empiric treatment for at least 14 days 6

The usual duration is 7-14 days for most bacterial meningitis cases 1

Evidence Supporting Once-Daily Dosing

Recent pharmacokinetic modeling specifically in children demonstrates that once-daily dosing achieves better early CSF penetration than twice-daily dosing 3. Historical studies confirm that 100 mg/kg once daily produces CSF levels of 3.3 mg/L at 6 hours on day 1, with trough levels at 24 hours still maintaining 0.47 mg/L at the end of treatment 8. All patients in these studies achieved CSF sterilization within 24-48 hours 4, 8.

Critical Pitfalls to Avoid

• Do not use doses lower than 100 mg/kg/day for meningitis - the standard 50-75 mg/kg/day used for other infections is insufficient for CNS penetration 1
• Do not administer with calcium-containing solutions - this can cause fatal precipitation in the lungs and kidneys, particularly dangerous in neonates 1
• Do not shorten treatment duration based on early clinical improvement alone - complete the full pathogen-specific course 6
• Ensure adequate treatment for S. pneumoniae - if penicillin-resistant strains are suspected, add vancomycin to the regimen 2

Adjunctive Therapy Considerations

• Add vancomycin 10-15 mg/kg every 6 hours if penicillin-resistant S. pneumoniae is suspected (targeting trough levels of 15-20 mg/L) 2
• Consider dexamethasone as adjunctive therapy, administered with or up to 4 hours after the first antibiotic dose 2