From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For a UTI in a patient with an eGFR of 24 mL/min, the recommended ceftriaxone IV dose is 1-2 grams once daily, with no dosage adjustment required. Ceftriaxone is primarily eliminated through biliary excretion (approximately 60%) rather than renal clearance, making it a suitable option for patients with renal impairment 1. The standard treatment duration for complicated UTIs is typically 7-14 days, depending on clinical response. When administering ceftriaxone, it should be infused over 30 minutes to minimize infusion-related reactions. Monitor renal function during therapy and assess clinical response within 48-72 hours. Consider oral step-down therapy once the patient shows clinical improvement and can tolerate oral medications. Despite the low eGFR, ceftriaxone remains effective against most urinary pathogens at standard doses while maintaining a favorable safety profile in renal impairment.
Some key points to consider when treating UTIs in patients with renal impairment include:
- The most common pathogen in UTI is Escherichia coli, and ceftriaxone has been shown to be effective against this pathogen 2
- The treatment strategies for UTIs in patients with renal impairment are based on the same principles as in patients with normal renal function, but drugs cleared by the kidney or by dialysis membranes need dose adjustment 1
- Ceftriaxone therapy should be considered carefully in patients with complicated UTIs due to the possibility of enterococcal re-infection and consequent prolonged hospital stay 3
- Fluoroquinolones are frequently prescribed for treatment of UTI in the outpatient setting, but data evaluating prescribing patterns after FDA safety warnings is limited, especially in urgent care settings 4
Overall, ceftriaxone is a suitable option for treating UTIs in patients with renal impairment, and the recommended dose is 1-2 grams once daily, with no dosage adjustment required.