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Prospective study of nephrolithiasis occurrence in children receiving cefotriaxone
Doaa Mohammed Youssef1, Laila Metwaly Sherief1, Hanan Saker Sherbiny1
1Pediatrics, Zagazig University, Egypt.
Insights
A short, 5-day course of Ceftriaxone antibiotic therapy in children was linked to kidney stone development. Even without predisposing factors, Ceftriaxone may increase the risk of pediatric nephrolithiasis.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Clinical Research
Background:
- Ceftriaxone is a widely used antibiotic in pediatric care.
- Previous reports suggest a link between high-dose Ceftriaxone and nephrolithiasis.
- The association between short-term Ceftriaxone treatment and kidney stone formation requires further investigation.
Purpose of the Study:
- To evaluate the association between a 5-day Ceftriaxone treatment course and nephrolithiasis in children.
- To determine if Ceftriaxone is an independent risk factor for kidney stone development in pediatric patients.
Main Methods:
- A study involving 120 pediatric patients, divided into two groups: 60 treated with Ceftriaxone (80 mg/kg/day for 5 days) and 60 with other antibiotics.
- Exclusion of patients with urinary tract infections (UTI) to avoid confounding factors.
- Assessment included abdominal ultrasound, serum urea, creatinine, serum calcium, and 24-hour urinary calcium/creatinine ratio before and after treatment.
Main Results:
- Five out of 60 patients (8.3%) receiving Ceftriaxone developed kidney stones.
- The calculi were small, spontaneously resolved in most cases, and occurred in patients with normal renal ultrasounds and no metabolic risk factors.
- Age was identified as a potential risk factor for nephrolithiasis in the Ceftriaxone group.
Conclusions:
- Ceftriaxone therapy, even for a short duration, was associated with renal stone formation in children.
- The findings suggest Ceftriaxone may be an independent predisposing factor for pediatric nephrolithiasis.
- Further research is warranted to understand the mechanism and clinical implications of Ceftriaxone-induced nephrolithiasis.
Aim:
Ceftriaxone is a commonly used antibiotic among the paediatric population. Various reports have associated high doses of Ceftriaxone with the development of nephrolithiasis; our aim was to test this association with a 5 day course of treatment.
Methods:
Our study group consisted of 120 patients divided into two groups. The first group included 60 patients who underwent treatment with Ceftriaxone therapy that was started empirically and continued for 5 days at the dose of 80 mg/kg per day. The second group (60 patients) who received treatment with other antibiotics (other than Ceftriaxone), as recommended by hospital protocols. Patients with urinary tract infections (UTI) were excluded as UTI may be a predisposing cause for nephrolithiasis. Baseline and follow up after 5 days were done with; abdominal ultrasound, serum urea, creatinine, serum calcium, 24 h urinary calcium and urinary calcium/ creatinine ratio. Extended metabolic tests were done for cases that developed nephrolithiasis.
Results:
Five cases out of the 60 patients treated with Ceftriaxone developed calculi; that were small and were eliminated spontaneously in four cases at mean duration of 3 weeks. In these cases renal ultrasonography examinations were normal prior to treatment; and none of them had metabolic disturbances or risk factors leading to stone formation. By multiple regression analysis, only age was related to nephrolithiasis formation being higher in the group that has developed stones.
Conclusion:
Only patients who underwent Ceftriaxone therapy have developed renal stones, even with a short course of therapy (5 days), and in the absence of a known predisposing cause for nephrolithiasis. We have thus concluded that Ceftriaxone by itself maybe a predisposing factor for nephrolithiasis.
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