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Clinical features and outcomes of pseudolithiasis induced by ceftriaxone in Chinese children: a single-center
Chen Jin1,2, Wen-Li Xiu1,2, Yao Liu1,2
1Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Insights
Ceftriaxone (CTX) can cause gallbladder pseudolithiasis (PL) in children, occurring in 18.4% of cases. Discontinuing CTX effectively resolves PL, with ultrasound being a key diagnostic tool.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Pharmacology
Background:
- Ceftriaxone (CTX) is a common antibiotic for pediatric infections.
- CTX-induced gallbladder pseudolithiasis (PL) poses diagnostic and management challenges in children.
Purpose of the Study:
- To investigate the incidence, clinical characteristics, and management strategies for CTX-induced PL in pediatric patients.
- To identify factors associated with the development of CTX-induced PL.
Main Methods:
- A retrospective case-control study involving 185 pediatric patients treated with CTX.
- Analysis of treatment regimens, gallbladder imaging (ultrasound), and serum biochemical markers.
- Classification of patients into PL (n=34) and non-PL (n=151) groups.
Main Results:
- PL occurred in 18.4% of pediatric patients receiving CTX.
- Patients with PL were older and taller, with higher rates of digestive and neurological infections.
- Distinct serum markers (bile acids, adenosine deaminase, lactate dehydrogenase, creatinine) were observed in the PL group.
- PL was not significantly correlated with CTX dosage.
Conclusions:
- Ultrasound is effective for monitoring CTX-induced PL in children.
- Discontinuation of CTX is an effective treatment for PL, with complete resolution within three months.
- CTX metabolism and excretion rates may influence PL development.
Introduction:
Ceftriaxone (CTX) is widely used in pediatric infectious disease treatment, although the diagnostic and therapeutic management of CTX-induced gallbladder pseudolithiasis (PL) remains challenging. In this study, we investigated the occurrence, clinical features, and management of CTX-induced PL in children.
Methods:
A retrospective case-control study was conducted on 185 pediatric patients receiving CTX at a single center. Data on treatment regimens, gallbladder imaging findings, and serum biochemical parameters post-CTX therapy were analyzed. Patients were classified into PL (n = 34) and non-PL (n = 151) groups based on imaging findings.
Results:
PL was diagnosed in 18.4% of patients treated with CTX, primarily through ultrasound, which revealed hyperechoic material within the gallbladder. Compared with the non-PL group, patients with PL were older and taller, with no significant differences in CTX dosage (p = 0.915). Patients with PL also had higher rates of digestive and neurological infections (both p < 0.001). Serum analysis revealed distinct liver and kidney function markers in the PL group, including lower levels of total bile acids, adenosine deaminase, and lactate dehydrogenase, and higher creatinine levels (all p < 0.05). Discontinuation of CTX led to symptom resolution in most cases, and all cases of PL resolved within three months.
Conclusions:
The occurrence of PL is not significantly related to CTX dosage. Furthermore, the rate of CTX metabolism and excretion may play a key role in PL development. Overall, the findings demonstrate that ultrasound is an effective tool for monitoring the development of PL in children receiving CTX and that discontinuation of CTX could be an effective treatment for PL.
