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KMID : 0816119980010010100
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Korean Journal of Pediatric Gastroenterolology and Nutrition
1998 Volume.1 No. 1 p.100 ~ p.106
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Ceftriaxone Associated Biliary Pseudolithiasis
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Kim Jae-Young
Koh Young-Yull
Lee Hoan-Jong
Seo Jeong-Kee
Ko Jae-Sung
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Abstract
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Purpose: Ceftriaxone, a potent parenteral third-generation semisynthetic cephalosporin
is widely used for the treatment of a variety of bacterial infections in both children and
adult. Review of recent data indicates that ceftriaxone treatment has been associated
with the development of reversible biliary pseudolithiasis and that is thought by many
to be a benign process. Despite, several reports describe patients with ceftriaxone
pseudolithiasis who required cholecystectomy for presumed acute cholecystitis. In this
study we evaluated the incidence, risk factors, and prognosis of gallbladder
pseudolithiasis after ceftriaxone treatment.
Methods: Between march, 1997 and January, 1998, any child admitted to the Children’s
hospital of National University of Seoul and prescribed ceftriaxone for probable or
definite bacterial infection were eligible for the study. 21 of them had ultrasound
examination on the 2∼12 days later after the start of ceftriaxone treatment, 8 of whom
documented gallbladder precipitates or pseudolithiasis during treatment by serial
abdominal ultrasound. Repeat abdominal ultrasound was performed 10∼80 days later
after the end of ceftriaxone treatment. The children with underlying liver disease or
decreased renal function were excluded in this study.
Results: 1) 21 children had ultrasound examinations of gallbladder during ceftriaxone
treatment and 8 (38%) of them acquired pseudolithiasis. 2) The patients who developed
gallbladder pseudolithiasis were significantly older (6.3±2.9 yr. vs 2.2±3.1 yr.)(p<0.05),
and older than 24 months were probably the significant risk associated with this
phenomenon (p<0.05). However, no significant differences in sex, type of infection,
fasting, and ceftriaxone treatment regimen (dose, duration of therapy). 3) The
abnormality found on gallbladder ultrasonography was a strikingly hyperechogenic
material with post-acoustic shadowing in 5 patients without post-acoustic shadowing in
3 patients 4) Follow up of gallbladder ultrasound was performed in 6 patients after
cessation of ceftriaxone treatment. Sonographic abnormalities completely resolved within
14 days post cessation of therapy in 2 patients; 30 days, 1 patient; 80 days, 3 patients.
Conclusions: We suggest that routine abdominal ultrasound should be considered in all
children who received high dose ceftriaxone in more than 24 months of age and
developed hepatobiliary symptoms during or just after ceftriaxone treatment.
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KEYWORD
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Reversible biliary pseudolithiasis, Ceftriaxone,
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