title: Acute cholecystitis and pancreatitis in a patient with biliary sludge associated with the use of ceftriaxone: a rare but potentially severe complication.
abstract: Ceftriaxone may precipitate in the bile leading to the formation of biliary sludge. Biliary complications, even serious ones, have rarely been described in patients treated with this antibiotic. A 71-year-old woman presented to the emergency room with biliary sludge complicated by acute cholecystitis and pancreatitis after 10 days of treatment with ceftriaxone (2 g, 40 mg/kg per day). There had been no evidence of sludge or gallstones on a transabdominal ultrasonography performed 6 months earlier. The patient underwent open cholecystectomy and recovered fully. Ceftriaxone should be kept in mind as a potential cause of biliary sludge. In most cases, resolution of sludge occurs after interruption of ceftriaxone. Young subjects, patients receiving a prolonged course and a daily dose > or = 40 mg/kg, and subjects with impaired gallbladder emptying have a greater risk of ceftriaxone-associated sludge. Cholecystectomy is the definitive therapy for severe complications.
authors.affiliation: Medicina d'Urgenza, Ospedale San Camillo di Roma.
authors.forename: G
authors.initials: G
authors.lastname: Famularo
authors.forename: S
authors.initials: S
authors.lastname: Polchi
authors.forename: C
authors.initials: C
authors.lastname: De Simone
mesh_terms: D000208:Acute Disease; D000368:Aged; D001646:Bile / Q000187:drug effects*; D002443:Ceftriaxone / Q000009:adverse effects*; D002511:Cephalosporins / Q000009:adverse effects*; D011232:Chemical Precipitation; D002763:Cholecystectomy; D002764:Cholecystitis / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D010195:Pancreatitis / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D013997:Time Factors
chemical_list: D002511:Cephalosporins; D002443:Ceftriaxone