Biliary pseudolithiasis during ceftriaxone therapy in children

Background: Ceftriaxone is almost widely used in the treatment of pediatric infection and this is accompanied by some complications. The aim of this study was to determine the incidence of abnormal ultrasonography findings of gallbladder (pseudolithiasis or sludge) during ceftriaxon therapy and its relation to fasting, sex and G6PD deficiency. Methods: This quasi-experimental survey was done in Amirkola Children's Hospital, Babol, Iran. First ultrasonography was done before initiation of ceftriaxone therapy and it was repeated 24-48 hours after therapy and in the 5th, 7th, 10th and 14th day after the treatment. If abnormal finding was seen, ultrasonography was done weekly in the first two weeks until the side effect disappeared. Data was collected and analyzed by SPSS software. Findings: Of all 108 patients, who were between 3 months to 10 years old, 20 cases had abnormal findings in gallbladder (2 sludges and 18 pseudolithiases). Length of fasting before ceftriaxone therapy had a positive relation with possibility of stone formation (p<0.005), but age, sex, duration of therapy and G6PD deficiency were not related (p<0.05). In four cases pseudolithiasis was formed after only 1-2 doses of ceftriaxone. Shortest and longest periods of resolution of complications were 1 and 17 days respectively after formation.Conclusion: Incidence of pseudolithiasis or sludge formation during ceftriaxone therapy was 18.5% and fasting had a great effect on these complications.