Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children

Abstract

Purpose Ceftriaxone is a widely used third‐generation cephalosporin. In this prospective study, we used sonography to investigate the incidence and outcome of biliary complications in children receiving ceftriaxone therapy. Methods Ceftriaxone was administered intravenously at a dosage of 100 mg/kg/day for 1–3 weeks to 118 children hospitalized for severe infection. Serial gallbladder sonograms were obtained on days 1, 5–7, and 10–14 of therapy and the day after therapy ended if it had lasted more than 2 weeks. When sonographic abnormalities were found, additional sonograms were obtained every 3 days until the abnormalities had completely resolved. Results Twenty patients (17%), all asymptomatic, demonstrated sonographic abnormalities: 8 had gallbladder sludge, defined as echogenic material without associated acoustic shadowing, and 12 had pseudolithiasis, defined as echogenic material with acoustic shadowing. These abnormalities spontaneously resolved within 2 weeks of stopping the ceftriaxone (mean time to disappearance, 8.2 ± 3.4 days). No significant differences were found between patients with normal versus abnormal sonographic findings in sex, age, duration of treatment, or other risk factors for drug precipitation. Conclusions Ceftriaxone‐associated biliary pseudolithiasis is usually asymptomatic and was rapidly reversible after cessation of therapy in this group of Turkish children. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:166–168, 2000.

Ceftriaxone-Associated Cholelithiasis in Adult Patients with Bacterial Meningitis

“…Therefore, high-dose or bolus administration of ceftriaxone, dehydration, hypoalbuminemia, calcium-containing transfusion material, and complication with renal diseases in the elderly and children are associated with an increased risk of developing ceftriaxone-induced cholelithiasis [17]. The two patients presented in this report were under long-term (3 weeks) administration of high-dose ceftriaxone (4 g/day) for bacterial meningitis treatment, and were under conditions that facilitated the formation of gallstones.…”

Pseudolithiasis due to Ceftriaxone Treatment for Meningitis in Children: Report of 8 Cases

“…The incidence of ceftriaxone-associated biliary sludge was reported between 17-57.5% (Schaad et al 1988;Papadopoulou et al 1999;Palanduz et al 2000;Herek et al 2001;Bor et al 2004;Ozturk et al 2005). Higher rates were reported with higher doses of ceftriaxone in those studies (100 mg/kg/day vs 60-70 mg/kg/day).…”

Prediction of Compatibility between Ozagrel Sodium Preparation for Injection and Calcium on the Basis of the Solubility Product

“…The mixture of ceftriaxone and calcium ion is known to have the potential to cause incompatibility, resulting in biliary sludge and pseudocholelithiasis; even death has been reported. [12][13][14][15][16][17] In the case of ozagrel-calcium, the ionic product was less than 25% of the K sp . That is, the SI was <1, indicating that the solution was unsaturated, and the presence of ozagrel-calcium salts is unlikely.…”