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Early biliary pseudolithiasis during ceftriaxone therapy for acute pyelonephritis in children: a prospective study in
1Service de Chirurgie Pédiatrique, Centre Hospitalier, Montmorency, France.
Insights
Ceftriaxone, a common antibiotic for children, can cause temporary gallstones. These usually disappear after treatment stops, and the drug
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Pharmacology
Background:
- Ceftriaxone, a third-generation cephalosporin, is widely used in children due to its once-daily dosing.
- This antibiotic is known to cause reversible gallbladder precipitates in both adults and children.
- Acute pyelonephritis is a common pediatric infection often treated with Ceftriaxone.
Purpose of the Study:
- To investigate the incidence and characteristics of biliary lithiasis (gallstones) induced by Ceftriaxone in children treated for acute pyelonephritis.
- To assess the reversibility of Ceftriaxone-induced gallstones after drug discontinuation.
Main Methods:
- A prospective study involving 34 children with acute pyelonephritis.
- Ceftriaxone administered as a single daily intravenous dose (50 mg/kg, max 2g/day).
- Gallbladder sonograms performed before treatment and before the fifth injection; follow-up sonograms conducted post-treatment.
Main Results:
- Five out of 34 children (15%) developed gallstones (1-2 stones) after 3-5 days of Ceftriaxone treatment.
- The affected children were asymptomatic, with a median age of 7 years.
- Gallstones resolved spontaneously in all cases within 2-5 months after discontinuing Ceftriaxone.
Conclusions:
- Ceftriaxone can induce precocious biliary lithiasis in children, which is typically reversible upon drug cessation.
- The occurrence of these gallstones appears unpredictable and not linked to age, sex, or specific therapy parameters in this cohort.
- Clinicians should be aware of this potential side effect to avoid misdiagnosis and unnecessary interventions, as the benefits of Ceftriaxone generally outweigh this reversible complication.
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.