Ceftriaxone (Xone) Pediatric Dosing Guidelines
Standard Dosing by Infection Severity
For most pediatric infections beyond the neonatal period, administer ceftriaxone 50-75 mg/kg/day given once daily or divided every 12-24 hours, with a maximum of 2 grams daily for non-meningeal infections. 1
Mild to Moderate Infections
- Standard dose: 50-75 mg/kg/day, administered once daily or divided every 12-24 hours 1
- This dosing is appropriate for:
Severe Infections
- High-dose regimen: 50-100 mg/kg/day, given once daily or divided every 12-24 hours 1
- Use the higher end (80-100 mg/kg/day) for:
Bacterial Meningitis
- Meningitis dose: 100 mg/kg/day divided every 12-24 hours, with a maximum of 4 grams daily 1
- After initial loading dose of 100 mg/kg, continue with 80 mg/kg once daily 3
- Duration: 10-14 days for gonococcal meningitis 1
Neonatal Dosing (Critical Age-Based Adjustments)
Postnatal Age ≤7 Days
- Dose: 50 mg/kg/day given every 24 hours 1
Postnatal Age >7 Days
- Weight ≤2000 g: 50 mg/kg/day given every 24 hours 1
- Weight >2000 g: 50-75 mg/kg/day given every 24 hours 1
Critical Neonatal Contraindication
- Never use ceftriaxone in hyperbilirubinemic neonates due to risk of bilirubin encephalopathy from displacement of bilirubin from albumin binding sites 1
Pathogen-Specific Dosing Considerations
Gram-Negative Enteric Bacilli
- Dose: 100 mg/kg/day divided every 12 hours OR 80 mg/kg/day every 24 hours (maximum 4 g daily) 1
Penicillin-Resistant Streptococcus pneumoniae
- For MIC <2.0 μg/mL: 50-100 mg/kg/day every 12-24 hours 2
- For MIC ≥4.0 μg/mL: 100 mg/kg/day every 12-24 hours 2
- This higher dosing ensures adequate CNS penetration and coverage of resistant strains 1
Gonococcal Infections (Weight <45 kg)
- Uncomplicated infections: 125 mg IM single dose 1
- Bacteremia or arthritis: 50 mg/kg/day (maximum 1 g) for 7 days 1
- Meningitis: 50 mg/kg/day (maximum 2 g) for 10-14 days 1
- Conjunctivitis: 25-50 mg/kg IV or IM single dose, not to exceed 250 mg 1
Endocarditis (HACEK Organisms)
- Dose: 100 mg/kg/day IV/IM once daily 1
- Duration: 4 weeks for native valve, 6 weeks for prosthetic valve 1
Administration Guidelines
Route of Administration
- Can be given intravenously or intramuscularly 1
- IM injection is painful - counsel patients and families accordingly 1
- For IM administration, inject deep into large muscle mass 1
Maximum Dose Limitations
- Non-meningeal infections: Maximum 2 grams daily 1
- Meningitis: Maximum 4 grams daily 1
- Pediatric doses should never exceed adult maximum doses 1
Clinical Efficacy Data
The evidence supporting these dosing recommendations is robust:
- Once-daily dosing at 50-80 mg/kg achieved 94% clinical cure rate and 97% bacteriologic cure rate across 201 serious pediatric infections 4
- For meningitis, 80 mg/kg once daily after 100 mg/kg loading dose achieved 100% bacteriologic cure with satisfactory CSF concentrations at 24 hours 3
- Single daily dosing provides efficacy equal to divided dosing schedules with greater ease of administration 5
Common Pitfalls to Avoid
- Do not underdose severe infections - always use 100 mg/kg/day for life-threatening infections, empyema, or documented resistant pneumococcus 1
- Do not use the lower end (50 mg/kg/day) for severe sepsis - use 80-100 mg/kg/day 1
- Never use in hyperbilirubinemic neonates regardless of indication 1
- Do not exceed maximum daily doses even in obese patients 1
Adverse Effects
- Most common: Diarrhea (20.4% in meningitis study, typically mild and self-limited) 3
- Neutropenia/leukopenia may occur but typically resolves with discontinuation 5
- Overall, only 10% experienced adverse effects, with none requiring discontinuation in the largest pediatric series 4
Note on Xone-XP Kid (Ceftriaxone/Tazobactam)
The provided evidence does not contain specific dosing guidelines for ceftriaxone/tazobactam combination products. Standard ceftriaxone dosing guidelines above apply to ceftriaxone monotherapy (Xone). For combination products, consult product-specific prescribing information as tazobactam component dosing may differ.