Comparative evaluation of ceftriaxone- and cefotaxime-induced biliary pseudolithiasis or nephrolithiasis: A prospective study in 154 children

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> Biliary lithiasis, or sludge, and nephrolithiasis have been reported as a possible complication of ceftriaxone therapy. However, no study related to cefotaxime-induced biliary pseudolithiasis or nephrolithiasis was observed in the literature. Therefore, we investigated the comparative formation of biliary pseudolithiasis and nephrolithiasis after cefotaxime and ceftriaxone therapies. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> The patients treated with ceftriaxone or cefotaxime were enrolled during the study period. Ultrasound imaging of the biliary and urinary tract was performed in all patients before and after the treatment. The patients with a positive sonographic finding at the end of treatment were followed up with monthly ultrasonography for 3 months. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The present study showed that abnormal biliary sonographic findings were demonstrated in 18 children (20.9%) treated with ceftriaxone, 13 (15.1%) had biliary lithiasis, 5 (5.8%) had biliary sludge and 1 (1.2%) had nephrolithiasis. Abnormal biliary sonographic findings were demonstrated in only four (5.9%) children treated with cefotaxime who had biliary sludge and only one (1.5%) had nephrolithiasis. It was observed that older age was at significantly higher risk of developing biliary sludge or stone formation. Receiver operating characteristic analysis was performed to determine the residual risk and analysis found that 4.5 years was the cut-off value for age. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> The present study is unique in the literature for reporting for the first time gall bladder sludge and nephrolithiasis associated with cefotaxime use. Therefore, patients treated with cefotaxime should be monitored for serious complications like patients treated with ceftriaxone. Nevertheless, if third-generation cephalosporin is used, cefotaxime is recommended to be used rather than ceftriaxone. </jats:p></jats:sec>

Safety of ceftriaxone in paediatrics: a systematic review

“…Concurrent use of intravenous ceftriaxone and calcium-containing solutions in neonates and young infants has been associated with calcium precipitation. Biliary pseudolithiasis and urolithiasis have also been reported in paediatric patients 6 7. There is a lack of overall assessment of the safety of ceftriaxone, one of the most widely used antibiotics in paediatric patients.…”

Цефалоспориніндукований Біліарний Сладж У Дітей

“…Данный факт соответствует исследованию, проведен-ному Lokman Ustoyl и соавт. [10], в результате которого авторы установили, что у детей старше 4,5 года значи-тельно возрастает риск развития ЦИБПЛ. По гендер-ному признаку отличий не наблюдалось (мальчиков -50 %, девочек -50 %).…”

“…Данный феномен полу-чил название «цефалоспорининдуцированный били- арный псевдолитиаз» (ЦИБПЛ). Билиарный сладж чаще развивается на фоне применения цефтриаксона (15-57 %) [6,7,9], но встречается и при использова-нии цефотаксима (5,9 %) [10] и цефтазидима (2 %) [11]. Считалось, что формирование преципитатов в поло-сти желчного пузыря на фоне применения цефтри-аксона носит исключительно транзиторный характер [6,7], однако результаты исследований последних лет опровергают абсолютную обратимость ЦИБПЛ.…”

Drug-Induced Urolithiasis in Pediatric Patients

“…In 1988, Schaad et al [26] reported the first case of ceftriaxone-induced nephrolithiasis in one child out of 37 children. Soon after that, several authors reported crystalluria [27,28], hypercalciuria [29,30] and urolithiasis [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] in children following ceftriaxone use. It is considered the most common lithogenic antibacterial drug in the pediatric population, with an incidence ranging from 0.6% [45] to 8.3% [31].…”

“…Cefotaxime is also a third-generation cephalosporin similar to ceftriaxone. Ustyol et al [38] compared the rate of biliary pseudolithiasis and nephrolithiasis between children using ceftriaxone and cefotaxime in the management of acute bacterial infection, showing no significant difference between these drugs in regard to drug-induced nephrolithiasis (1.2% vs 1.5%, p > 0.05). This is the only report in the literature about cefotaxime-induced nephrolithiasis in the pediatric population, and further studies are required to confirm the lithogenic effect of this antibacterial drug.…”