Ceftriaxone-associated nephrolithiasis in children

Area of Science:

• Pediatric Nephrology
• Pediatric Infectious Diseases
• Pediatric Gastroenterology

Background:

• Ceftriaxone, a third-generation cephalosporin, is frequently used to treat pediatric infections.
• Complications such as urinary tract lithiasis and gallbladder pseudolithiasis/sludge are associated with ceftriaxone use in children.
• Understanding the incidence and risk factors for these complications is crucial for patient safety.

Purpose of the Study:

• To investigate the incidence of nephrolithiasis and gallbladder stones in pediatric patients treated with ceftriaxone.
• To identify predisposing factors associated with the development of these ceftriaxone-induced complications.

Main Methods:

• A quasi-experimental, before-and-after study involving 96 hospitalized children receiving ceftriaxone (50-100 mg/kg/day).
• Sonographic examinations of the urinary tract and gallbladder were performed before and after treatment.
• Patients with positive findings were followed with serial sonography.

Main Results:

• Post-treatment sonography revealed nephrolithiasis in 6.3% and gallbladder stones in 1% of pediatric patients; all were asymptomatic.
• Nephrolithiasis showed a significant association with male gender (P=0.02).
• No significant differences were found regarding age, weight, diagnosis, season, dosage, or treatment duration between groups with and without nephrolithiasis.

Conclusions:

• Pediatric patients may develop small, asymptomatic renal stones during short-term ceftriaxone therapy.
• Close monitoring for nephrolithiasis and gallbladder sludge/pseudolithiasis is recommended, especially for those on high-dose, long-term ceftriaxone treatment.