Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children.
OBJECTIVE
Ceftriaxone is a widely used third-generation cephalosporin. In this prospective study, we used sonography to investigate the incidence and outcome of biliary complications in children receiving ceftriaxone therapy.


METHODS
Ceftriaxone was administered intravenously at a dosage of 100 mg/kg/day for 1-3 weeks to 118 children hospitalized for severe infection. Serial gallbladder sonograms were obtained on days 1, 5-7, and 10-14 of therapy and the day after therapy ended if it had lasted more than 2 weeks. When sonographic abnormalities were found, additional sonograms were obtained every 3 days until the abnormalities had completely resolved.


RESULTS
Twenty patients (17%), all asymptomatic, demonstrated sonographic abnormalities: 8 had gallbladder sludge, defined as echogenic material without associated acoustic shadowing, and 12 had pseudolithiasis, defined as echogenic material with acoustic shadowing. These abnormalities spontaneously resolved within 2 weeks of stopping the ceftriaxone (mean time to disappearance, 8.2 +/- 3.4 days). No significant differences were found between patients with normal versus abnormal sonographic findings in sex, age, duration of treatment, or other risk factors for drug precipitation.


CONCLUSIONS
Ceftriaxone-associated biliary pseudolithiasis is usually asymptomatic and was rapidly reversible after cessation of therapy in this group of Turkish children.
Palanduz
A
A
Department of Pediatrics, University of Istanbul, Istanbul Faculty of Medicine, Capa 34390, Istanbul, Turkey.
Yalçin
I
I
Tonguç
E
E
Güler
N
N
Oneş
U
U
Salman
N
N
Somer
A
A
D000293:Adolescent; D002443:Ceftriaxone / Q000009:adverse effects*; D011232:Chemical Precipitation; D002648:Child; D002675:Child, Preschool; D002769:Cholelithiasis / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012075:Remission, Spontaneous; D014463:Ultrasonography
D002443:Ceftriaxone