Ceftriaxone-induced pseudolithiasis in children treated for perforated appendicitis.
OBJECTIVE
Ceftriaxone has been associated with development of pseudolithiasis. In our institution, it is used for treatment of perforated appendicitis in children. This study evaluated the occurrence of ceftriaxone-related pseudolithiasis in this population.


METHODS
After obtaining IRB approval, we performed a retrospective chart review over 51 months. We included patients undergoing laparoscopic appendectomy for perforated appendicitis. All patients were treated with ceftriaxone post-operatively. Patients without initial or post-treatment gallbladder imaging available for review were excluded.


RESULTS
There were 71 patients who met inclusion criteria with a mean (±SD) age of 10.8 ± 3.8 years. Of these, 14 % (n = 10) developed stones or sludge in the gallbladder. The mean duration of ceftriaxone therapy was 8.7 ± 3.8 days. The average time to post-antibiotic imaging was 11.5 ± 10.3 days from initiation of antibiotics. There was no significant difference in duration of ceftriaxone therapy in the children that developed pseudolithiasis or sludge (10.0 ± 4.9 days) compared to those that did not (8.5 ± 3.6, p = 0.26). One child (10 %) with pseudolithiasis went on to become symptomatic, requiring a laparoscopic cholecystectomy.


CONCLUSIONS
In our experience, ceftriaxone use for perforated appendicitis is associated with a significant incidence of biliary pseudolithiasis, and is unrelated to duration of ceftriaxone therapy.
Department of Surgery, Center for Prospective Clinical Trials, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
Hanna
H
Alemayehu
Amita A
AA
Desai
Priscilla
P
Thomas
Susan W
SW
Sharp
Shawn D
SD
St Peter
D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001064:Appendicitis / Q000188:drug therapy* / Q000601:surgery*; D002443:Ceftriaxone / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002769:Cholelithiasis / Q000139:chemically induced*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone