Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children

Purpose. Ceftriaxone is a widely used third-generation cephalosporin. in th is prospective study, we used sonography to investigate the incidence and o utcome of biliary complications in children receiving ceftriaxone therapy. Methods. Ceftriaxone was administered intravenously at a dosage of 100 mg/k g/day for 1-3 weeks to 118 children hospitalized for severe infection. Seri al 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 s onographic abnormalities were found, additional sonograms were obtained eve ry 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 with out associated acoustic shadowing, and 12 had pseudolithiasis, defined as e chogenic material with acoustic shadowing. These abnormalities spontaneousl y resolved within 2 weeks of stopping the ceftriaxone (mean time to disappe arance, 8.2 +/- 3.4 days). No significant differences were found between pa tients with normal versus abnormal sonographic findings in sex, age, durati on of treatment, or other risk factors for drug precipitation. Conclusions. Ceftriaxone-associated biliary pseudolithiasis is usually asym ptomatic and was rapidly reversible after cessation of therapy in this grou p of Turkish children. (C) 2000 John Wiley & Sons, Inc.