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Risk Factors for Ceftriaxone-Associated Pseudolithiasis in Adults
Akihiro Matsumi1, Takeshi Tomoda1,2, Hiroyuki Terasawa1
1Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Digestion
|March 12, 2023
Summary
Ceftriaxone (CTRX) can cause pseudolithiasis in adults, with incidence at 17%. Risk factors include longer CTRX use, high doses, fasting, and chronic kidney disease, necessitating consideration in differential diagnoses.
Area of Science:
- Pharmacology
- Gastroenterology
- Nephrology
Background:
- Ceftriaxone (CTRX) is a commonly used antibiotic.
- CTRX is known to occasionally cause pseudolithiasis (calcium crystal formation in the gallbladder).
- While observed in children, data on incidence and risk factors in adults are limited.
Purpose of the Study:
- To investigate the incidence of Ceftriaxone-associated pseudolithiasis in adults.
- To identify independent risk factors for developing pseudolithiasis during CTRX treatment.
Main Methods:
- Single-center retrospective study.
- Included 523 adult patients treated with Ceftriaxone.
- Computed tomography (CT) scans were used to confirm pseudolithiasis before and after CTRX administration.
Main Results:
- The incidence of CTRX-associated pseudolithiasis was 17% (89 out of 523 patients).
- Independent risk factors identified: abdominal biliary disease (OR 0.19), CTRX administration >3 days (OR 5.0), CTRX dose of 2 mg (OR 5.2), fasting >2 days (OR 3.2), and eGFR <30 mL/min/1.73 m2 (OR 3.4).
- Statistical significance was observed for all identified risk factors (p < 0.0017).
Conclusions:
- Ceftriaxone-associated pseudolithiasis is a relevant condition in adults.
- Consider pseudolithiasis in adult patients with abdominal pain or elevated liver enzymes post-CTRX.
- Particular vigilance is needed in patients with chronic kidney disease, those fasting, or receiving high-dose CTRX therapy.
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