Early Biliary Pseudolithiasis During Ceftriaxone Therapy for Acute Pyelonephritis in Children: A Prospective Study in 34 Children

Abstract

The prolonged biological half-life of Ceftriaxone, allowing once-daily dosing, has contributed to the large diffusion of this third-generation cephalosporin in children. Ceftriaxone is known to induce reversible precipitates in the gallbladder of adults and children. A prospective study was conducted during 1997 in 34 children admitted for the treatment of acute pyelonephritis. Ceftriaxone (intravenous daily single-dose of 50 mg/kg under 2g/day) was initially used. A first gallbladder sonogram, performed before the first or second injection, was normal in all cases. A second evaluation was performed before the fifth and last injection. On this second evaluation the presence of one (n = 3) or two gallstones was recorded in 5 children (15%) on a sonogram made after 3 (n = 4) or 5 (n = 1) injections. Their median age was 7 years (range 4 months to 11 years). All five children remained symptom-free and the normalization of the sonographic patterns was constant on the last sonogram performed 2 (n = 1), 3 (n = 2) and 5 months (n = 2) after discontinuation of Ceftriaxone. This study confirms the possibility of precocious biliary lithiasis under Ceftriaxone therapy in childhood and their spontaneous dissolution after discontinuation of the drug. They seem unpredictable and independent of the age, sex in a cohort homogeneous for the nature of the infection, modality of a short- and low-dose therapy. Clinicians and radiologists should be aware of this complication as an etiology of a so-called primary cholelithiasis and to prevent anxiety or unnecessary cholecystectomy. The antibacterial and pharmacokinetic benefits of Ceftriaxone outweigh the problem of reversible biliary pseudolithiasis with this drug.

Increased urinary calcium excretion caused by ceftriaxone: possible association with urolithiasis

“…These biochemical characteristics of ceftriaxone treatment frequently cause biliary sludge or pseudolithiasis, a well-known side effect in children [2][3][4][5]. This complication may develop after 2-16 days of treatment initiation [4-6, 13, 14] and is characterized by asymptomatic biliary changes; in most cases, it is reversible [3,13]. Prospective studies have revealed that the incidence of pseudolithiasis is 25-50% in children being treated with ceftriaxone [2,3,15].…”

Ceftriaxone Associated Biliary Sludge in Children - A Study in Bangabandhu Sheikh Mujib Medical University

“…The longest time interval i.e. 5 months of resolution of sludge was reported by Bonnet et al 13 . In the present study comparison was made between the biliary sludge formation group and normal group ( Table-II).…”

In Vitro Assessment of the Formation of Ceftriaxone–Calcium Precipitates in Human Plasma

“…Taking into account these higher concentrations of ceftriaxone and calcium, and the stasis in the urinary bladder as well as in the gallbladder, it is comprehensible why renal and biliary lithiasis emerges. 18,[41][42][43][44][45] Therefore, biliary precipitation and nephrolithiasis limit the C max that can be achieved in vivo.…”