J Korean Pediatr Soc.  2000 Aug;43(8):1090-1097.

A Prospective Study on Ceftriaxone-associated Biliary Pseudolithiasis: A Dose-related Comparison

• Lee SJ
• Kim JH
• Jeong JH
• Cho SM
• Park ST
• Choi DS
• Lee HK

Abstract

PURPOSE: Ceftriaxone, a parenteral third-generation cephalosporine, is widely used in the treatment of various bacterial infections. It possesses high calcium-binding affinity, forming complexes with calcium in bile salts to develop precipitate that mimics gallstone on ultrasonography. Biliary pseudolithiasis resolves completely with cessation of therapy, but several symptomatic patients have undergone cholesystectomy. We prospectively evaluated the incidence, risk factors and dose- related comparison with ultrasonography.
METHODS
Between November 1998 and August 1999, 81 cases of inpatients on ceftriaxone treatment in Dongguk University Pohang Hospital were enrolled for this study. They were divided according to dose of ceftriaxone, high-dose and low-dose groups. Repeated sonography was performed on 1, 3, 5 and 7 days after initiation of ceftriaxone treatrnent and then weekly until pseudolithiasis were resolved.
RESULTS
Thirty-eight percent of the subjects acquired pseudolithiasis. Sonographic abnormalities appeared from 1 to 10 days after ceftriaxone therapy and completely resolved from 1 to 24 days after cessation of ceftriaxone therapy. The incidence of pseudolithiasis was significantly higher in the high-dose group(P<0.001). In the high-dose group, fasting over a day was a significant risk factor of pseudolithiasis(P<0.01). Sex, age, duration of ceftriaxone therapy, laboratory findings, type of infection or chief complaint were not significant risk factors for pseudolithiasis.
CONCLUSION
We suggest that abdominal ultrasonography should be considered in all children who receive high dose ceftriaxone with fasting over a day. If pseudolithiasis was developed, we can detect the most of resolution after 30 days of cessation of therapy.

Keyword

Ceftriaxone; Biliary pseudolithiasis; Dose-related

MeSH Terms

Bacterial Infections
Bile Acids and Salts
Calcium
Ceftriaxone
Child
Fasting
Gallstones
Gyeongsangbuk-do
Humans
Incidence
Inpatients
Prospective Studies*
Risk Factors
Ultrasonography
Bile Acids and Salts
Calcium
Ceftriaxone