Incidence of gallbladder lithiasis after ceftriaxone treatment

Abstract

Ceftriaxone has potent activity against a broad range of Gram-positive and Gramnegative bacteria. While it is Hjminat^ mainly by the kidney, 10-20% of the drug is eliminated in the bile and ceftriaxone salt precipitates have been described in the gallbladder of animals dosed with ceftriaxone. The purpose of the present study was to investigate the incidence of binary litniasis 6 and 12 months after treatment with ceftriaxone and to compare it with that in patients treated with amoxyciUin/ clavulanate. Biliary ultrasonography was performed at the start of treatment, at 6 months and at 12 months after the beginning of the study. One hundred patients were randomized and 74 were evaluable: 34 were given amoxycillin/clavulanate, 40 ceftriaxone. Gallbladder litniasis developed in one patient 12 months after the amoxycillin/clavulanate treatment and in none in the ceftriaxone treatment arm. Biliary precipitate during ceftriaxone treatment was not looked for because this phenomenon was not known at the beginning of the study, but gallbladder precipitation that was seen in two patients given ceftriaxone during and at the end of treatment, respectively, resolved spontaneously.In conclusion, ceftriaxone treatment does not appear to lead to gallstone formation more often than an antibiotic that is not eliminated through the bile.

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

“…With the growing popularity of CFIX since its release in 1984, numerous cases of biliary complications have been identified in children or adolescents since 1986 (2 -5,12,17 -20) then in adults (6,8,11,13,15,24). Biliary symptoms and sonographie abnormalities have been collectively termed as "biliary pseudolithiasis" (19), to emphasize the fact that they usually disappear following discontinuation of the drug, and the striking similarity with gallstones on ultrasound.…”

“…Ceftriaxone (CFfX) is known to induce reversible precipitates that mimic a gallstone on sonograms in the gallbladder of children and adults. This phenomenon has gained the attention of internists, pediatrici ans and radiologists (2)(3)(4)(5)(6)(7)(8)(10)(11)(12)14,15,17,(18)(19)(20)24), but it has not been reported in the surgicalliterature. No mention is made from biliary complications associated with CFfX therapy in arecent discussion concerning cholelithiasis accompanying urinary tract infections in childhood (9).…”

Hepatocellular enzyme elevations in a patient receiving ceftriaxone

“…Ceftriaxone's ability to cause druginduced gallstones or sludge is wellknown. Multiple case reports 16-33 and prospective studies [34][35][36][37][38][39][40][41][42] in the medical literature describe the relationship between ceftriaxone and the development of biliary pseudolithiasis or gallbladder sludge in adults and children.…”

Progressive Pseudolithiasis Associated with the Intravenous Administration of Ceftriaxone in Patients with Central Nervous System Infections

“…CTRX-induced pseudolithiasis has been reported to appear in 17-43% of children of 1 month to 18 years of age who are treated with CTRX (50-100 mg/kg/day) for 4-22 days ( 1 , 11 ). In contrast, among adult patients pseudolithiasis was reported to appear in 5% of patients who were treated with CTRX (2 g/day) for 10-14 days ( 12 ), 21% of patients who were treated with CTRX (2 g/day) for 14 days ( 4 ), and 25% of patients who were treated with CTRX (3 g/day) for 4-17 days ( 3 ). Abdominal pain was only reported in 2 of these previous reports, and the biliary sludge resolved at 7-26 days after the discontinuation of CTRX.…”