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Comparative evaluation of ceftriaxone- and cefotaxime-induced biliary pseudolithiasis or nephrolithiasis: A
L Ustyol1, M D Bulut2, K Agengin3
11 Department of Pediatric Nephrology, Yuzuncuyıl University, Van, Turkey.
Insights
Ceftriaxone is more likely to cause biliary sludge and kidney stones than cefotaxime. Older children face a higher risk of these complications, necessitating monitoring for both antibiotics.
Area of Science:
- Pharmacology
- Gastroenterology
- Nephrology
Background:
- Biliary lithiasis and nephrolithiasis are known complications of ceftriaxone therapy.
- Limited data exists on cefotaxime-induced biliary pseudolithiasis or nephrolithiasis.
- This study compares these risks between cefotaxime and ceftriaxone.
Purpose of the Study:
- To compare the incidence of biliary pseudolithiasis and nephrolithiasis between cefotaxime and ceftriaxone treatments.
- To identify risk factors, such as age, associated with these complications.
Main Methods:
- Patients receiving ceftriaxone or cefotaxime were enrolled.
- Biliary and urinary tract ultrasounds were performed pre- and post-treatment.
- Patients with positive findings were monitored with monthly ultrasounds for 3 months.
Main Results:
- Ceftriaxone led to abnormal biliary findings in 20.9% of children (15.1% lithiasis, 5.8% sludge) and 1.2% nephrolithiasis.
- Cefotaxime resulted in biliary sludge in 5.9% and nephrolithiasis in 1.5% of children.
- Older age (cut-off 4.5 years) was a significant risk factor for biliary sludge/stone formation.
Conclusions:
- This study is the first to report gallbladder sludge and nephrolithiasis associated with cefotaxime.
- Patients on cefotaxime require monitoring for potential serious complications.
- Cefotaxime is recommended over ceftriaxone if a third-generation cephalosporin is necessary.
Background:
Biliary lithiasis, or sludge, and nephrolithiasis have been reported as a possible complication of ceftriaxone therapy. However, no study related to cefotaxime-induced biliary pseudolithiasis or nephrolithiasis was observed in the literature. Therefore, we investigated the comparative formation of biliary pseudolithiasis and nephrolithiasis after cefotaxime and ceftriaxone therapies.
Methods:
The patients treated with ceftriaxone or cefotaxime were enrolled during the study period. Ultrasound imaging of the biliary and urinary tract was performed in all patients before and after the treatment. The patients with a positive sonographic finding at the end of treatment were followed up with monthly ultrasonography for 3 months.
Results:
The present study showed that abnormal biliary sonographic findings were demonstrated in 18 children (20.9%) treated with ceftriaxone, 13 (15.1%) had biliary lithiasis, 5 (5.8%) had biliary sludge and 1 (1.2%) had nephrolithiasis. Abnormal biliary sonographic findings were demonstrated in only four (5.9%) children treated with cefotaxime who had biliary sludge and only one (1.5%) had nephrolithiasis. It was observed that older age was at significantly higher risk of developing biliary sludge or stone formation. Receiver operating characteristic analysis was performed to determine the residual risk and analysis found that 4.5 years was the cut-off value for age.
Conclusions:
The present study is unique in the literature for reporting for the first time gall bladder sludge and nephrolithiasis associated with cefotaxime use. Therefore, patients treated with cefotaxime should be monitored for serious complications like patients treated with ceftriaxone. Nevertheless, if third-generation cephalosporin is used, cefotaxime is recommended to be used rather than ceftriaxone.
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