Ceftriaxone-associated gallbladder pseudolithiasis is a not uncommon complication of this common antibiotic, where a ceftriaxone-calcium precipitate forms gallbladder sludge. It appears more common in pediatric patients.
In one series, 25% of pediatric patients developed gallbladder pseudolithiasis whilst receiving ceftriaxone 1.
Approximately 40% of ceftriaxone is excreted into the biliary system, and ceftriaxone can concentrate in the gallbladder and can participate with calcium resulting in the formation of a ceftriaxone-calcium complex 2,3.
Sludge appearing as a hyperechoic layer without posterior acoustic shadowing 2.
Treatment and prognosis
This phenomenon may be fully reversible, taking between 2 and 63 days to resolve post cessation of treatment 2. Ceftriaxone can be a cause of gallstone formation.
- 1. Papadopoulou F, Efremidis S, Karyda S, Badouraki M, Karatza E, Panteliadis C, Malaka K. Incidence of ceftriaxone-associated gallbladder pseudolithiasis. (1999) Acta paediatrica (Oslo, Norway : 1992). 88 (12): 1352-5. Pubmed
- 2. Choi YY, Jung YH, Choi SM, Lee CS, Kim D, Hur KY. Gallbladder pseudolithiasis caused by ceftriaxone in young adult. (2011) Journal of the Korean Surgical Society. 81 (6): 423-6. doi:10.4174/jkss.2011.81.6.423 - Pubmed
- 3. Aditi Nayak, Adam Slivka. Ceftriaxone-Induced Gallstones: Case Report and Literature Review. (2014) ACG Case Reports Journal. 1 (3): 170. doi:10.14309/crj.2014.40 - Pubmed
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