Ceftriaxone-associated side effect findings in children’s abdominal ultrasonography

Abstract

Ceftriaxone is a third-generation cephalosporin, which has a broad spectrum of activity against Gram-negative and Gram-positive bacteria. It can sometimes induce biliary sludge or stone formation because of the interaction with Calcium ions. The aim of this study is to describe the epidemiology of the side effects after the ceftriaxone therapy in hospitalized pediatric patients and to follow up the group of suspected Ceftriaxone-induced adverse effects. Methods: This prospective study was conducted in different Pediatric Services of the University Hospital Center “Mother Theresa”, Tirana, during the period October 2021-March 2022. We studied the ultrasonographic data of 80 patients admitted to these services, who had been on Ceftriaxone therapy. Results: All the females aged from 5-10 years old, and males aged from 6-12 years old, underwent ultrasound examination for other reasons and 21.25% of the cases resulted with pseudolithiasis, while 3.75% with nephrolithiasis. According to the total number of cases, 70.6% of them were asymptomatic. Only 29.4 % of the patients referred right upper quadrant pain and 1 of them showed nausea. The symptoms began from 5th-7th day and last 20 days. The ultrasound imaging performed from 5th- 10th days after Ceftriaxone administration, showed gallbladder sludge and pseudolithiasis in the symptomatic patients, ranged 8-12 mm, and renal microlithiasis <3mm. These patients were followed with ultrasound exam after 1 month. Conclusion: From all pediatric patients treated with Ceftriaxone and followed with ultrasonography, 21.25% resulted with collateral associated gallbladder pseudolithiasis as side effect from ceftriaxone-therapy, found by ultrasonographic evaluation. None of the cases was complicated with gallbladder hydrops, pancreatitis or hydronephrosis. After the Ceftriaxone therapy was discontinued, the condition resolved spontaneously. Key Words: ceftriaxone, gallbladder pseudolithiasis, nephrolithiasis, ultrasound