Ceftriaxone Dosing for Meningitis

Pharmacokinetic Rationale

• The UK Joint Specialist Societies recommend 2g IV every 12 hours for bacterial meningitis in adults, due to limited CNS penetration of ceftriaxone, which achieves mean CSF trough levels of 3.5-7.9 mcg/mL 1
• The ESCMID guidelines specify 2g every 12 hours or 4g every 24 hours for adult meningitis, as the limited CNS penetration requires sustained high plasma concentrations to maintain therapeutic CSF levels 2, 3

Clinical Guidelines

• The treatment duration is typically 10-14 days for pneumococcal meningitis and 5 days for meningococcal meningitis, reflecting the need for sustained CNS drug exposure, as recommended by the UK Joint Specialist Societies and ESCMID guidelines 1, 4