Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child

Prince, Jeffrey S.; Senac, Melvin O.

doi:10.1007/s00247-003-0963-0

Cited by 47 publications

(34 citation statements)

References 11 publications

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“…In Cochat et al's study, urolithiasis was reported in a 13-year-old boy with meningitis following 9 days of ceftriaxone treatment [8]. Prince and Senac described a case of urolithiasis following ceftriaxone treatment for epidural abscess [9], and Grasberger et al reported a 6-year-old girl with acute peritonitis following appendectomy who was treated with ceftriaxone (100 mg/kg/day), amikacin, and metronidazole. The patient developed acute renal failure due to renal calculi on the 10th day of treatment [10].…”

Section: Discussionmentioning

confidence: 97%

Ceftriaxone associated nephrolithiasis: a prospective study in 284 children

et al. 2007

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Urinary tract calculi have been reported to account for between 1 in 1,000 and 1 in 7,600 hospital admissions in children in the USA. The annual incidence of urolithiasis in patients older than 10 years is 109 per 100,000 of the population in men and 36 per 100,000 of the population in women in Minnesota. The use of various medications is considered to be one of the etiologic factors of nephrolithiasis. Ceftriaxone is a widely used third-generation cephalosporin that is generally considered very safe, but complications such as biliary pseudolithiasis, and rarely, nephrolithiasis have been reported in children. There is limited information about urolithiasis as a side effect of ceftriaxone. The aim of this study was evaluation of the incidence of nephrolithiasis following ceftriaxone therapy in children. This quasi-experimental before and after study was conducted in Mofid Children's Hospital between 2003 and 2005. All patients were treated with 75 mg/kg intravenous ceftriaxone. Diagnosis of pyelonephritis was based on standard criteria. The first renal ultrasonography was performed on the first or second day of admission and was repeated on the last day of treatment. We also evaluated complicated patients for the third time with renal ultrasonography 3 months after treatment. Stone-forming patients underwent metabolic kidney stone risk factor evaluation. We evaluated 284 patients with pyelonephritis, 185 girls and 99 boys. The first ultrasonography was normal in all of our patients. On the second ultrasonography renal stones were reported in 4 out of 284 cases (1.4% and CI=0.96-1.83%). Underlying metabolic risk factors could not be identified in stone-forming patients. Follow-up ultrasonography 3 months later was normal. The results of our study suggest that ceftriaxone-treated patients may be at an increased risk of kidney stone formation. Stones passed spontaneously in all affected patients so the use of this effective drug can be safely continued. Close monitoring of ceftriaxone-treated patients with regard to kidney stone formation is recommended.

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Section: Discussionmentioning

confidence: 97%

Ceftriaxone associated nephrolithiasis: a prospective study in 284 children

et al. 2007

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“…The highly protein-bound agent ceftriaxone is not recommended for neonates with concerns of meningitis due to the risk of acute bilirubin encephalopathy from displacement of free bilirubin by the drug (225). It has also been rarely associated with biliary pseudolithiasis, nephrolithiasis, and pulmonary impairment due to precipitation with calcium ions in neonates with both elevated and normal serum calcium levels (226)(227)(228)(229)(230).…”

Section: Empirical Antibiotic Therapymentioning

confidence: 99%

Early-Onset Neonatal Sepsis

et al. 2014

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SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.

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“…The literature supports early recognition, observation, and thus prevention of unnecessary surgical intervention [2,9,18,23,24]. Consideration of this diagnosis in patients on ceftriaxone with biliary symptoms is advised, so as to avoid unnecessary cholecystectomy.…”

Section: Discussionmentioning

confidence: 90%

Acute necrotizing cholecystitis: a rare complication of ceftriaxone-associated pseudolithiasis

2006

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A 16-year-old male patient (59 kg) who presented to his primary care physician with a 3 week history of lethargy and myalgias. His physical examination was notable for a 5-cm bullseye lesion on his right foot, which was thought to be a spider bite. This resolved without treatment after 1 week. He developed a similar lesion on his left forearm, which also resolved on its own after 1 week. Four weeks after his symptoms began, he presented to our institution with a headache, jaw stiffness, and left-sided facial weakness (Bell's Palsy). He had a white blood cell count of 32,000 (normal 4,000-10,000). Lyme titers were positive. A lumbar puncture was performed and he was diagnosed with Lyme meningitis. He was treated with ceftriaxone 2 g intravenously twice a day for 4 weeks.The patient developed right upper quadrant pain 1 week after completing his treatment. The pain was intermittent and gradually became more severe over the next 2 weeks. He was seen again at our institution and an abdominal ultrasound was performed. It showed multiple gallstones with one gallstone in the gallbladder neck and mild gallbladder wall thickening (4 mm). There was no pericholecystic fluid and the common bile duct appeared normal. Due to his persistent and worsening symptoms, he underwent a laparoscopic cholecystectomy. He had a significant amount of inflammation around the gallbladder with indiscernible anatomy, and thus we converted to an open procedure.The pathological analysis showed acute necrotizing cholecystitis with surface erosions. The stone analysis by polarization microscopy and infrared spectroscopy revealed that the stone composition was 100% ceftriaxone (Laboratory for Stone Research, Newton, MA, USA). DiscussionCeftriaxone is a parenteral broad-spectrum, semi-synthetic third generation cephalosporin. A b-lactam antibiotic, it exerts its antibacterial activity through the inhibition of bacterial cell-wall synthesis. Its spectrum of activity includes many gram-positive aerobic bacteria, gram-negative aerobic bacteria and some anerobes. It is resistant to degradation by most bacterial b-lactamases [6]. Ceftriaxone's pharmacokinetic properties are nonlinear and all basic pharmacokinetic parameters (e.g. absorption and distribution), with the exception of the elimination half-life, are dose dependent. Its long halflife of elimination (i.e. 5.4 -10.9 h) allows for once or twice daily dosing.Although it is largely excreted in the urine, 10-40% is excreted unmetabolized in bile [5,7,17,22,29]. It is reversibly bound to albumin, and the binding decreases with the increase in concentration, e.g. from 95% binding at plasma concentrations less than 100 mg/l to 85% binding at 300 mg/l [17]. Due to the lower albumin content in interstitial fluid, the percentage of free drug in interstitial fluid is correspondingly higher than in plasma. As a result, the levels of ceftriaxone in the bile is 20-150 times greater than in serum [25]. As an anion, it binds to calcium and forms an insoluble calcium-ceftriaxone salt in a 1:1 molar ratio that is...

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Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child

Cited by 47 publications

References 11 publications

Ceftriaxone associated nephrolithiasis: a prospective study in 284 children

Ceftriaxone associated nephrolithiasis: a prospective study in 284 children

Early-Onset Neonatal Sepsis

Acute necrotizing cholecystitis: a rare complication of ceftriaxone-associated pseudolithiasis

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