Ceftriaxone-Induced Pancreatitis in a Pediatric Patient: Case Report

Abstract

We describe the first case of probable ceftriaxone-induced pancreatitis in a 2-year-old child. The patient was admitted to Santobono-pausilipon Children's Hospital with fever, vomiting and diarrhea and was treated with ceftriaxone 700 mg/day by intramuscular route. After the second administration of ceftriaxone, laboratory data revealed an increase in amylase. The patient's abdomen was mildly distended and diffusely painful. Drug-induced pancreatitis was considered and ceftriaxone was immediately discontinued, but after 24 hours laboratory data showed a further increase in amylase and an increase in lipase. Three days after interruption of ceftriaxone, the child's symptoms had improved. based on a) biochemical, clinical and instrumental parameters, b) criteria of drug-induced pancreas disorders and c) the Naranjo adverse drug reaction probability scale, we made a diagnosis of probable ceftriaxone-induced pancreatitis. To our knowledge, this is the first case report of probable primary ceftriaxone-induced pancreatitis in children.

Drug-induced acute pancreatitis: results from the hospital-based Berlin case-control surveillance study of 102 cases

“…22 Interestingly, several cephalosporins, including cefuroxime, cefotaxime and cefixime, showed a possible or probable causal relationship in our causality assessment of individual cases. To this day, ceftriaxone has been the only antibiotic of this class to be reported associated with AP, [23][24][25][26][27][28] possibly via formation of gallstones. 24 As cases of biliary AP were excluded from our study, it seems that this pathomechanism of ceftriaxone-induced AP may not apply to all other cephalosporins.…”

The importance of monitoring adverse drug reactions in pediatric patients: the results of a national surveillance program in Italy

“…In the case of domperidone, a follow-up study showed that its use in dysphagic pediatric patients affected by brain injury could be optimized, and the risk of vomiting minimized by assessing the presence/absence of pyloric obstructions via a gastric transit examination early after initiating domperidone administration [33]. The most frequently reported therapeutic main group of drugs in previous European studies were antibiotics [18,34,35]. We instead found that vaccines (hexavalent, anti-pneumococcal, anti-meningococcus, trivalent measles/mumps/rubella) were those most commonly reported, in line with another observational survey [18,[36][37][38].…”

Cholecystectomy during ceftriaxone therapy. A translational study with a new rabbit model

“…In approximately 60% of these cases, the carriers of biliary lithiasis are asymptomatic, but when symptoms or clinical signs are manifested, nearly 70% of the patients will undergo surgical procedures due to acute or chronic cholecystitis 15 . When biliary microlithiasis (stones up to 3 mm) is present, typically involving multiple calculi, and approximately 20% of patients develop pancreatitis, as the microlithiasis may migrate to the common bile duct and pass through the papilla causing relevant injuries associated with an acute inflammatory process 16,17 . It must be emphasized that ceftriaxone has a broad spectrum of action with a long half-life.…”