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Apparent biliary pseudolithiasis during ceftriaxone therapy.

K L Heim-Duthoy1, E M Caperton, R Pollock

  • 1Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota 55415.

Antimicrobial Agents and Chemotherapy
|June 1, 1990
PubMed
Summary
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Ceftriaxone treatment can cause temporary gallbladder abnormalities, including biliary pseudolithiasis, in some patients. These ultrasound findings typically resolve after discontinuing the antibiotic.

Area of Science:

  • Pharmacology
  • Gastroenterology
  • Medical Imaging

Background:

  • Biliary pseudolithiasis, or "sludge," is a known potential side effect of ceftriaxone therapy.
  • Previous reports suggest a link between ceftriaxone use and gallbladder abnormalities.
  • The exact incidence and clinical significance of ceftriaxone-associated gallbladder changes require further investigation.

Purpose of the Study:

  • To investigate the association between intravenous ceftriaxone administration and the development of gallbladder abnormalities.
  • To evaluate the incidence of biliary pseudolithiasis in patients receiving ceftriaxone compared to a placebo.
  • To determine the resolution rate of these gallbladder changes after ceftriaxone discontinuation.

Main Methods:

  • A double-blind, placebo-controlled study involving 44 adult patients receiving 2 g of intravenous ceftriaxone or placebo daily for 14 days.

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  • Serial gallbladder sonograms were performed at baseline, day 14 of therapy, and 2 weeks post-therapy.
  • Patients with abnormal baseline sonograms were excluded from the primary analysis; 36 patients with normal baseline scans were evaluated.

    • Main Results:

    • Abnormal gallbladder sonograms developed in 6 of 28 (21.4%) ceftriaxone-treated patients versus 1 of 8 (12.5%) placebo recipients (P = 0.491).
    • Most affected ceftriaxone patients were asymptomatic (4/6), while two reported vomiting.
    • Gallbladder abnormalities resolved spontaneously in ceftriaxone patients between 9 and 26 days post-therapy.

    Conclusions:

    • Ceftriaxone treatment is associated with a higher incidence of transient gallbladder abnormalities detected by ultrasound.
    • These ceftriaxone-induced gallbladder changes are typically asymptomatic and resolve after drug cessation.
    • The findings support an association between ceftriaxone and reversible biliary pseudolithiasis.