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[Incidence, evolution and clinical behavior of pseudocholelithiasis associated with ceftriaxone in children]
Diego Andrés Rodríguez Rangel1, Laura Daniela Arenas Camacho2, Nicolas Andres Quiroga Barrera2
1Clínica Sanluis, Santander, Colombia.
Insights
Ceftriaxone-associated pseudocholelithiasis affects one in three children, often causing abdominal pain. Risk factors include age over five, low fluid intake, and obesity, but it is self-limiting.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Pharmacology
Background:
- Ceftriaxone-associated pseudocholelithiasis is a frequent yet underdiagnosed complication in pediatric patients.
- This condition, though typically self-limiting, can present with significant symptoms.
Purpose of the Study:
- To determine the incidence and clinical course of ceftriaxone-induced pseudocholelithiasis in children.
- To identify risk factors and clinical manifestations associated with this condition.
Main Methods:
- A prospective, observational study included 80 pediatric patients (1 month to 18 years) receiving ceftriaxone.
- Hepatobiliary ultrasound and clinical follow-up were conducted regularly to monitor for pseudocholelithiasis and its resolution.
- Statistical analyses, including Pearson's chi-square and Fisher's exact tests, were used to explore risk factors.
Main Results:
- The prevalence of pseudocholelithiasis was 35%, with symptoms like abdominal pain reported in 42.9% of affected children.
- Higher incidence was observed in children older than 5 years, those with lower fluid intake, and those who were overweight or obese.
- The condition resolved spontaneously within an average of 19.1 days.
Conclusions:
- Ceftriaxone-associated pseudocholelithiasis is common in children, affecting approximately one-third of patients.
- Key risk factors include older age, dehydration, and obesity.
- The condition is generally self-limiting, though symptomatic presentations are frequent.
Abstract:
Ceftriaxone-associated pseudocholelithiasis is common but underdiagnosed in children, occurring in up to half of those receiving ceftriaxone. Although self-limiting, it is frequently accompanied by symptoms.
Objective:
To report the incidence, course, risk factors, and clinical behavior of pseudocholelithiasis in children receiving ceftriaxone.
Patients And Method:
Prospective, descriptive, observational case series study. Patients aged 1 month to 18 years who received ceftriaxone were included. Clinical follow-up and hepatobiliary ultrasound were performed at the start of treatment and every 5 days until complete resolution. Association with risk factors was explored. Statistics used included Pearson's chi-square test and Fisher's exact test.
Results:
Eighty patients were included, 51.2% were male, median age 4.5 years (range 5 months to 17 years). The prevalence of pseudocholelithiasis was 35% (28 patients), documented in 6 and 27 patients during the first and second ultrasound (21.4% and 96.4%). Pseudocholelithiasis was significantly more frequent in the age group older than 5 years, those with lower fluid intake, obese, overweight, and very rare in malnourished patients (all p < 0.05). Twelve patients presented abdominal pain as a cardinal symptom (42.9%). The mean duration of the stones was 19.1 (5-44) days.
Conclusion:
Ceftriaxone-associated pseudocholelithiasis is common, occurring in 1 out of 3 children who receive it. Its main risk factors were age over 5 years, lower fluid intake, overweight, and obesity. Abdominal pain is frequent, and the progression was self-limited.
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