Early biliary pseudolithiasis during ceftriaxone therapy for acute pyelonephritis in children: A prospective study in 34 children

The prolonged biological half-life of Ceftriaxone, allowing once-daily dosi ng, has contributed to the large diffusion of this third-generation cephalo sporin in children. Ceftriaxone is known to induce reversible precipitates in the gallbladder of adults and children. A prospective study was conducte d during 1997 in 34 children admitted for the treatment of acute pyelonephr itis. Ceftriaxone (intravenous daily single-dose of 50 mg/kg under 2 g/day) was initially used. A first gallbladder sonogram, performed before the fir st or second injection, was normal in all cases. A second evaluation was pe rformed before the fifth and last injection. On this second evaluation the presence of one (n = 3) OF two gallstones was recorded in 5 children (15%) on a sonogram made after 3 (n = 4) or 5 (n = 1) injections. Their median ag e was 7 years (range 4 months to 11 years). All five children remained symp tom-free and the normalization of the sonographic patterns was constant on the last sonogram performed 2 (n = 1), 3 (n = 2) and 5 months (n = 2) after discontinuation of Ceftriaxone. This study confirms the possibility of pre cocious biliary lithiasis under Ceftriaxone therapy in childhood and their spontaneous dissolution after discontinuation of the drug. They seem unpred ictable and independent of the age, sex in a cohort homogeneous for the nat ure of the infection, modality of a short- and low-dose therapy. Clinicians and radiologists should be aware of this complication as an etiology of a so-called primary cholelithiasis and to prevent anxiety or unnecessary chol ecystectomy. The antibacterial and pharmacokinetic benefits of Ceftriaxone outweigh the problem of reversible biliary pseudolithiasis with this drug.