Ceftriaxone-associated biliary pseudolithiasis in children

Area of Science:

• Pediatric Pharmacology
• Diagnostic Imaging
• Adverse Drug Reactions

Background:

• Ceftriaxone is a commonly used antibiotic in pediatric care.
• The drug is known to cause reversible precipitations in the gallbladder and urinary tract, termed pseudolithiasis.
• Understanding the incidence and risk factors for ceftriaxone-induced pseudolithiasis is crucial for patient management.

Purpose of the Study:

• To determine the incidence of gallbladder and urinary tract pseudolithiasis in children treated with ceftriaxone.
• To identify predisposing factors associated with the development of ceftriaxone-induced pseudolithiasis.

Main Methods:

• A prospective study involving 156 children treated with varying daily doses of ceftriaxone (50, 75, 100 mg/kg).
• Sonographic examinations of the gallbladder and urinary tract were conducted at multiple time points: pre-treatment, day 3, day 7, and at 1 and 2 months post-treatment.
• Patients with positive findings were monitored weekly until resolution.

Main Results:

• Ceftriaxone-induced pseudolithiasis was observed in 17% of children (27/156).
• Gallbladder abnormalities included lithiasis (10%) and sludge (7%). Urolithiasis occurred in 0.6% of patients.
• Pseudolithiasis was more common in older children and those receiving higher ceftriaxone doses (P < 0.01 and P < 0.05).

Conclusions:

• Biliary pseudolithiasis, and less commonly nephrolithiasis, frequently occurs in pediatric patients receiving high-dose ceftriaxone.
• The condition is typically asymptomatic and reversible, resolving within approximately 16 days after drug discontinuation.
• Clinicians should be aware of this reversible complication and avoid unnecessary surgical interventions like cholecystectomy when symptoms arise.