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Ceftriaxone-associated biliary pseudolithiasis in children: do we know enough?

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Ceftriaxone antibiotic use in children can cause biliary pseudolithiasis, often asymptomatic. This condition typically resolves after stopping the drug, advocating a conservative management approach.

Keywords:
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Area of Science:

  • Pediatric Pharmacology
  • Gastroenterology
  • Antibiotic Stewardship

Background:

  • Ceftriaxone is a widely used antibiotic in pediatric hospital settings for severe bacterial infections.
  • Ceftriaxone use is associated with an increased incidence of cholelithiasis and biliary sludge, particularly in children.

Purpose of the Study:

  • To systematically review the literature on ceftriaxone-associated biliary pseudolithiasis in pediatric patients.
  • To analyze the clinical aspects, management, and outcomes of this complication.

Main Methods:

  • A comprehensive literature search was conducted using Medline and Embase databases up to December 2019.
  • Keywords included 'ceftriaxone', 'cholelithiasis', 'biliary sludge', 'gallstones', 'neonates', 'children', 'clinical aspects', and 'management'.

Main Results:

  • Evidence from case reports, series, and studies confirms a link between ceftriaxone and biliary pseudolithiasis in children, though data for neonates are limited.
  • The complication is dose-dependent, usually asymptomatic, but can manifest with abdominal pain, nausea, and emesis.
  • Abdominal ultrasonography is recommended for diagnosis.

Conclusions:

  • Ceftriaxone-associated cholelithiasis in children generally resolves post-therapy, supporting a conservative management strategy with potential need for prolonged follow-up.
  • Personalized risk assessment before prescribing ceftriaxone may minimize the occurrence of this complication, offering significant clinical and economic benefits.