Use of Ceftriaxone in Pediatric Medicine
Important Notice: This reference is for healthcare professionals only. Always verify doses and check for contraindications before prescribing. Consult current guidelines and drug information for complete details.
Drug Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against gram-positive and gram-negative bacteria. It's widely used in pediatric practice due to its once-daily dosing schedule and excellent CSF penetration.
Key Features
- Long half-life (5.8-8.7 hours in children)
- High protein binding (85-95%)
- Excellent CSF penetration (particularly with inflamed meninges)
- Primarily renal excretion (33-67%)
- Partial biliary excretion (40%)
Clinical Applications
| Indication | Typical Dose | Duration |
|---|---|---|
| Meningitis | 100 mg/kg/day | 7-14 days |
| Sepsis | 75-100 mg/kg/day | 7-10 days |
| Community-acquired pneumonia | 50-75 mg/kg/day | 5-7 days |
| Complicated UTI | 50-75 mg/kg/day | 7-14 days |
| Acute otitis media | 50 mg/kg/day | 1-3 days |
Dose Calculator
Contraindications and Precautions
- Hypersensitivity to cephalosporins or penicillins
- Neonatal jaundice - may displace bilirubin from albumin binding sites
- Concurrent calcium-containing solutions or products
- Severe liver disease with coagulopathy
Special Populations
Neonates (<28 days):
- Maximum daily dose: 50 mg/kg/day
- Increased risk of kernicterus in jaundiced neonates
- Monitor bilirubin levels closely
Adverse Effects and Monitoring
| System | Effects | Monitoring |
|---|---|---|
| Gastrointestinal | Diarrhea (3-10%), nausea, vomiting, C. difficile infection | Monitor stool frequency and consistency |
| Hepatobiliary | Biliary sludge/pseudolithiasis (especially >10 days therapy) | LFTs if treatment >14 days |
| Hematologic | Eosinophilia, thrombocytosis/thrombocytopenia, leukopenia | CBC with differential if treatment >7 days |
| Renal | Transient elevation in creatinine, oliguria (rare) | BUN/Cr in prolonged therapy |
Drug Interactions
| Drug/Solution | Interaction | Management |
|---|---|---|
| Calcium-containing products | Risk of precipitation - can be fatal in neonates | Separate administration by 48h in neonates, 24h in other ages |
| Aminoglycosides | Physical incompatibility | Administer at separate sites/times |
| Oral contraceptives | May reduce effectiveness | Advise alternative contraception |
Administration Guidelines
IV Administration
- Reconstitution:
- 1g vial: Add 10mL sterile water (95.7 mg/mL)
- 2g vial: Add 20mL sterile water (95.7 mg/mL)
- Further dilution required for infusion:
- Standard concentration: 20-40 mg/mL
- Maximum concentration: 40 mg/mL
- Infusion time:
- ≤50 mg/kg: Minimum 30 minutes
- >50 mg/kg: Minimum 60 minutes
IM Administration
- Maximum concentration: 250-350 mg/mL
- Maximum volume per injection site:
- Infants: 0.5 mL
- Children: 1 mL
- Adolescents: 2 mL
- Dilute with 1% Lidocaine to reduce injection pain
Clinical Pearls
- Calcium Precipitation Risk:
- No calcium-containing solutions within 48 hours in neonates
- Includes parenteral nutrition with calcium
- Risk highest in neonates and premature infants
- Biliary Sludging:
- More common with high doses and prolonged therapy
- Usually reversible upon discontinuation
- Consider ultrasound if symptoms develop
- CSF Penetration:
- Excellent penetration (inflamed meninges: ~10-20%)
- Maintains bactericidal levels for 24h in CSF
Recent Updates and Guidelines
2024 Key Updates
- Duration of Therapy:
- Shorter courses (5-7 days) now recommended for uncomplicated pneumonia
- Single-dose treatment remains effective for uncomplicated UTI
- Antimicrobial Resistance:
- Monitor local resistance patterns
- Consider alternative therapy in areas with >20% resistance
Evidence-Based Recommendations
| Recommendation | Evidence Level | Key Points |
|---|---|---|
| Empiric meningitis therapy | Strong (A) | First-line with vancomycin in areas with resistant S. pneumoniae |
| Single-dose UTI | Moderate (B) | Consider local resistance patterns |
| CAP treatment | Strong (A) | Effective monotherapy in typical cases |
References and Resources
- Red Book® 2024: Report of the Committee on Infectious Diseases
- WHO Guidelines on Prevention and Treatment of Serious Bacterial Infections
- National Institute for Health and Care Excellence (NICE) Guidelines
- American Academy of Pediatrics Clinical Practice Guidelines
Disclaimer: Guidelines and recommendations may vary by region and institution. Always consult local antimicrobial stewardship programs and current institutional protocols. This reference is meant to supplement, not replace, clinical judgment and current prescribing information.
