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Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children
A Palanduz1, I Yalçin, E Tonguç
1Department of Pediatrics, University of Istanbul, Istanbul Faculty of Medicine, Capa 34390, Istanbul, Turkey.
Insights
Ceftriaxone (a third-generation cephalosporin) can cause asymptomatic biliary pseudolithiasis in children. These gallbladder abnormalities resolve quickly after discontinuing the antibiotic therapy.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Radiology
Background:
- Ceftriaxone is a commonly prescribed third-generation cephalosporin antibiotic.
- Biliary complications are a potential side effect of certain antibiotic therapies.
Purpose of the Study:
- To investigate the incidence and outcomes of biliary complications in children treated with ceftriaxone.
- To assess the reversibility of ceftriaxone-associated biliary abnormalities.
Main Methods:
- Prospective study involving 118 children receiving intravenous ceftriaxone (100 mg/kg/day for 1-3 weeks).
- Serial gallbladder sonography performed at specific intervals during and after therapy.
- Abnormalities were monitored with additional ultrasounds until resolution.
Main Results:
- 17% of children (20 out of 118) developed sonographic biliary abnormalities.
- Abnormalities included gallbladder sludge (8 patients) and pseudolithiasis (12 patients), all asymptomatic.
- These findings resolved spontaneously within two weeks of ceftriaxone cessation.
Conclusions:
- Ceftriaxone-associated biliary pseudolithiasis is a generally asymptomatic condition in pediatric patients.
- The observed biliary abnormalities are typically reversible upon discontinuation of ceftriaxone therapy.
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.