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Biliary precipitation during ceftriaxone therapy: frequency and risk factors
Ahmet Soysal1, Kemal Eraşov, Ihsan Akpinar
1Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey.
The Turkish Journal of Pediatrics
|February 6, 2008
Summary
Ceftriaxone commonly causes temporary biliary precipitation in children, with increased risk in those over 12 months, higher doses, or longer treatment. Asymptomatic cases do not require intervention.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Pharmacology
Background:
- Ceftriaxone, a third-generation cephalosporin, is a common antibiotic for pediatric infections.
- A significant portion of ceftriaxone is excreted unmetabolized into bile.
- Potential for ceftriaxone to cause biliary complications warrants investigation.
Purpose of the Study:
- To determine the incidence of biliary sludge (BS) and biliary lithiasis (BL) in children treated with ceftriaxone.
- To identify clinical characteristics and risk factors associated with ceftriaxone-induced biliary precipitation (BP).
- To evaluate the outcomes of pediatric patients who develop BP during ceftriaxone therapy.
Main Methods:
- Prospective study involving 114 children receiving ceftriaxone.
- Biliary ultrasonography performed at baseline, day 5, day 10, and end of treatment.
- Weekly follow-up ultrasounds for patients who developed BS until resolution.
Main Results:
- 31% of children developed biliary precipitation (BP), including biliary sludge (BS) and biliary lithiasis (BL).
- Higher incidence of BP was associated with age over 12 months, ceftriaxone dose >2g/day, and treatment duration >5 days.
- All patients who developed BP were asymptomatic during treatment.
Conclusions:
- Ceftriaxone frequently induces transient biliary precipitation in children.
- Risk factors for BP include older age, higher dosage, and prolonged treatment duration.
- Asymptomatic biliary precipitation does not necessitate further investigation or treatment cessation.
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