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Ceftriaxone-associated biliary sludge and pseudocholelithiasis during childhood: a prospective study
Ozcan Bor1, Ener Cagri Dinleyici, Mahmut Kebapci
1Department of Pediatrics and Radiology, Faculty of Medicine, Osmangazi University, Meselik, Eskisehir, Turkey.
Insights
Ceftriaxone therapy can cause reversible biliary sludge or cholelithiasis in children, a condition that typically resolves on its own. This study found abnormal gallbladder findings in 36.8% of pediatric patients receiving ceftriaxone.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
- Medical Imaging
Background:
- Cholelithiasis (gallstones) is uncommon in children.
- Ceftriaxone is a commonly used antibiotic in pediatric care.
- The potential for ceftriaxone to induce biliary abnormalities requires investigation.
Purpose of the Study:
- To determine the frequency of biliary sludge and cholelithiasis in children undergoing ceftriaxone therapy.
- To assess the reversibility and clinical significance of these biliary findings.
Main Methods:
- Ultrasonographic examinations were performed on 38 children (1 month to 17 years) at the start and on the 10th day of ceftriaxone therapy.
- Follow-up scans were conducted monthly for patients with biliary sludge or cholelithiasis until resolution.
- Abnormalities were monitored for persistence after therapy cessation.
Main Results:
- Abnormal gallbladder sonograms were observed in 36.8% of patients by the 10th day of therapy.
- Cholelithiasis was diagnosed in 28.9% and biliary sludge in 7.9% of the children.
- While most cases resolved spontaneously, one child had persistent cholelithiasis for over 60 days, experiencing symptoms post-therapy.
Conclusions:
- Ceftriaxone-induced biliary sludge or pseudocholelithiasis is a notable, albeit reversible, condition in pediatric patients.
- These findings are generally benign and resolve spontaneously.
- Clinical signs associated with these ceftriaxone-induced biliary changes are typically absent or transient.
Background:
Cholelithiasis is a rare condition seen during childhood. The aim of this study was to determine frequency of biliary sludge and cholelithiasis with ceftriaxone therapy.
Methods:
Thirty-eight children aged between 1 month and 17 years were evaluated with ultrasonographic examination at the initiation of the ceftriaxone therapy and 10th day of therapy, consecutively. If biliary sludge or cholelithiasis were demonstrated, scans were repeated monthly until pathology disappeared.
Results:
Abnormal gallbladder sonograms were demonstrated in 36.8% (n = 14) of patients at the 10th day of therapy. Cholelithiasis was detected in 28.9% (n = 11) of patients and biliary sludge was detected in 7.9% (n = 3). Two children still had cholelithiasis at the 30th day after therapy and one had cholelithiasis after the 60th day. The 9-year-old girl who still had cholelithiasis after 60 days of therapy also had nausea, vomiting and abdominal pain at 7 days after cessation of therapy. Her 90th day sonographic examination was normal.
Conclusion:
Reversible biliary sludge or pseudocholelithiasis due to ceftriaxone treatment is not a rare condition. Therefore it is benign, spontaneously resolved and clinical signs are usually absent.
