Ceftriaxone Concentration for Intravenous Administration in Neonates
For a 22-day-old, 3.6 kg neonate receiving Rocephin (ceftriaxone) intravenously, the recommended concentration is 10-40 mg/mL, with administration over 60 minutes to reduce the risk of bilirubin encephalopathy. 1
Standard Concentration Guidelines
The FDA-approved concentration range for IV ceftriaxone is 10-40 mg/mL, with lower concentrations (10 mg/mL) preferred if desired. 1
For neonates specifically, the FDA mandates administration over 60 minutes (not 30 minutes as in older children) to minimize the risk of bilirubin encephalopathy. 1
Practical Preparation for This Patient
For a 22-day-old neonate (postnatal age >7 days and >2000 g), the recommended dose is 50-75 mg/kg/day given every 24 hours. 2, 1
For this 3.6 kg patient, the calculated daily dose would be 180-270 mg once daily. 2
To prepare a 200 mg dose at 10 mg/mL concentration: reconstitute with 20 mL of compatible diluent (0.9% sodium chloride, 5% dextrose, or sterile water for injection). 1
To prepare a 200 mg dose at 40 mg/mL concentration: reconstitute with 5 mL of compatible diluent. 1
Critical Safety Considerations
CONTRAINDICATION: Ceftriaxone should NOT be used in hyperbilirubinemic neonates due to risk of bilirubin encephalopathy from displacement of bilirubin from albumin binding sites. 2, 1
Do NOT use diluents containing calcium (such as Ringer's solution or Hartmann's solution) as particulate formation can result. 1
Compatible diluents include: 0.9% sodium chloride, 5% dextrose in water (D5W), or sterile water for injection. 1
Administration Protocol
Administer the diluted solution as an IV infusion over 60 minutes (not as an IV push). 1
The 60-minute infusion time in neonates is specifically mandated to reduce bilirubin displacement risk, compared to the 30-minute infusion used in older children and adults. 1
Stability After Reconstitution
Reconstituted ceftriaxone solutions at 10 mg/mL remain stable for 2 days at room temperature (25°C) or 10 days refrigerated (4°C) when prepared with sterile water, 0.9% sodium chloride, or 5% dextrose. 1
Solutions at higher concentrations (250-350 mg/mL) remain stable for 24 hours at room temperature or 3 days refrigerated. 1