Safety of ceftriaxone in paediatrics: a systematic review

Abstract

ObjectiveTo determine the safety of ceftriaxone in paediatric patients and systematically evaluate the categories and incidences of adverse drug reactions (ADRs) of ceftriaxone in paediatric patients.MethodsWe performed a systematic search in Medline, PubMed, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, International Pharmaceutical Abstracts and bibliographies of relevant articles up to December 2018 for all types of studies that assessed the safety of ceftriaxone in paediatric patients aged ≤18 years.Results112 studies met the inclusion criteria involving 5717 paediatric patients who received ceftriaxone and reported 1136 ADRs. The most frequent ADRs reported in prospective studies were gastrointestinal (GI) disorders (37.4 %, 292/780), followed by hepatobiliary disorders (24.6%, 192/780). Serious ADRs leading to withdrawal or discontinuation of ceftriaxone were reported in 86 paediatric patients. Immune haemolytic anaemia (34.9%, 30/86) and biliary pseudolithiasis (26.7%, 23/86) were the two major causes. Haemolytic anaemia following intravenous ceftriaxone led to death in 11 children whose primary disease was sickle cell disease. Almost all biliary pseudolithiasis are reversible. However, the incidence was high affecting one in five paediatric patients (20.7%).ConclusionsGI ADRs are the most common toxicity of ceftriaxone in paediatric patients. Immune haemolytic anaemia and biliary pseudolithiasis are the most serious ADRs and the major reasons for discontinuation of ceftriaxone. Immune haemolytic anaemia is more likely in children with sickle cell disease and may cause death. Ceftriaxone should be used with caution in children with sickle cell disease.Trial registration numberCRD42017055428

Biliary pseudolithiasis in an older patient treated with lascufloxacin

“…Biliary pseudolithiasis has been mainly reported in pediatric patients treated with ceftriaxone, with a frequency of 25% according to a systematic review. 7 To the best of our knowledge, this is the first report of pseudolithiasis caused by LSFX. As clinical symptoms alone might not always suggest pseudolithiasis, the exact frequency in the older adult population is unknown.…”

Acute post-streptococcal glomerulonephritis – immune-mediated acute kidney injury – case report and literature review

“…The most frequently reported ADRs were gastrointestinal disorders (37.4%, 292/780), followed by hepatobiliary disorders (24.6%, 192/780). Almost all cases of biliary pseudolithiasis were reversible; however, the incidence was surprisingly high, affecting one in five pediatric patients (20.7%) [38]. Notably, the incidence of biliary pseudolithiasis might be even higher in patients with renal function impairment as drug biliary excretion rises in case of kidney insufficiency.…”

Ceftriaxone-Induced Gallbladder Stones in Children

“…It is also seen as less common in children compared to adults. Ceftriaxone is a third-generation of the cephalosporins class with a broad-spectrum antibacterial coverage and is used for the treatment of severe bacterial infections like osteomyelitis, gastrointestinal, and meningitis in the children's population [4,10]. It is far more extensively distributed in most body tissues and fluids and can penetrate bloodbrain barriers into the meninges [3,4,14].…”

“…Ceftriaxone is a third-generation of the cephalosporins class with a broad-spectrum antibacterial coverage and is used for the treatment of severe bacterial infections like osteomyelitis, gastrointestinal, and meningitis in the children's population [4,10]. It is far more extensively distributed in most body tissues and fluids and can penetrate bloodbrain barriers into the meninges [3,4,14]. Because of the prolonged plasma half-life, it can also be excreted by the urine, and 40% is secreted by the bile duct [3], and it can be administered once daily and every 12 hours in the case of complex infection in some children.Most medications have adverse drug reactions, including ceftriaxone that has been reported as a causative agent for pseudolithiasis either in the gall bladder or renal tract [4,5,14].…”

“…It is far more extensively distributed in most body tissues and fluids and can penetrate bloodbrain barriers into the meninges [3,4,14]. Because of the prolonged plasma half-life, it can also be excreted by the urine, and 40% is secreted by the bile duct [3], and it can be administered once daily and every 12 hours in the case of complex infection in some children.Most medications have adverse drug reactions, including ceftriaxone that has been reported as a causative agent for pseudolithiasis either in the gall bladder or renal tract [4,5,14]. It is also known as biliary pseudolithiasis or reversible Choleolithiasis based on Ultrasound findings [10].…”