Concomitant Ceftriaxone-induced Nephrolithiasis and Biliary Pseudolithiasis in a Small Toddler

Gimiga Nicoleta¹, Miron Ingrith¹, Mocanu Adriana^1, , Olaru Claudia¹, Stanca Raluca² and Diaconescu Smaranda¹

¹Department of Pediatrics, “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania

²Gastroenterology Unit, “St. Mary” Children’s Emergency Hospital, Iasi, Romania

Cite this paper

Gimiga Nicoleta, Miron Ingrith, Mocanu Adriana, Olaru Claudia, Stanca Raluca and Diaconescu Smaranda. Concomitant Ceftriaxone-induced Nephrolithiasis and Biliary Pseudolithiasis in a Small Toddler. American Journal of Medical Case Reports. 2015; 3(12):422-424. doi: 10.12691/AJMCR-3-12-11

Abstract

Ceftriaxone is commonly used in pediatric practice and has been associated to biliary pseudolithiasis, nephrolithiasis and bladder sludge. We report a case of a 5-month old male toddler previously treated with high ceftriaxone doses for interstitial pneumonia; after one week an improvement of respiratory symptoms was noticed but extreme agitation and excessive crying occurred. He eliminated small white crystals that were found in the diaper and were proven to be constituted from calcium carbonate; abdominal ultrasound showed also a hyperechoic image of 4 mm in the gallbladder. Laboratory data were within normal rangers except a slight increase of the urinary calcium and calcium/creatinine ratio. The patient didn’t have any risk factor for ceftriaxone- induced lithiasis except high dosage of the antibiotic together with idiopathic hypercalciuria. Antibiotic interruption together with hydrochlorothiazide, adequate hydration and antispasmodics led to the remission of the symptoms and disappearance of the gallbladder image within 5 weeks. Ceftriaxone treatments should be routinely monitored by ultrasounds for the urinary and biliary system; appropriate dosage and administration with an adequate hydration are required.

Keywords

ceftriaxone, children, nephrolithiasis, biliary pseudolithiasis

Copyright

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References

[1]	Adu A, Armour CL. Drug utilisation review (DUR) of the third generation cephalosporins. Focus on ceftriaxone, ceftazidime and cefotaxime. Drugs 1995; 50(3): 423-39.
[2]	Popescu GA, Pistol A, serban R. Consumul de antibiotice, Rezistenta microbiana si Infectii Nosocomiale in Romania (CARMIN-ROM 2012). http://www.cnscbt.ro/index.php/analiza-date-supraveghere/infectii-nosocomiale-1/238-raport-privind-supravegherea-in-rezistenta-microbiana-si-consum-antibiotice-2012/file.
[3]	Stork CM: Antibiotics, antifungals, and antivirals. In Nelson LH, Flomenbaum N, Goldfrank LR, Hoffman RL, Howland MD, Lewin NA: Goldfrank's toxicologic emergencies. New York McGraw-Hill 2009: 847.
[4]	Wesdorp I, Bosman D, de Graaf A et al. Clinical presentations and predisposing factors of cholelitiasis and sludge in children. J Pediatr Gastroenterol Nutr 2000; 31(4): 411-7.
[5]	Youssef DM, Sherief LM, Sherbiny HS, Al Attar MY, El Sheikh AR, Fawzy FM, Adham T. Prospective study of nephrolithiasis occurrence in children receiving Cefotriaxone. Nephrology (Carlton) 2015.
[6]	Li N, Zhou X, Yuan J, Chen G, Jiang H, Zhang W. Ceftriaxone and Acute Renal Failure in Children. Pediatrics 2014; 133(4): e917-22.
[7]	Stojanovic V, Djuric Vijatov G. Nephrolithiasis caused by ceftriaxone in a 3-year-old child with ureteropelvic junction obstruction. Case Report Med 2009; 2009: 365962.
[8]	Dalton BR, Zuege DJ, Shahpori R, Laupland KB. Concomitant Ceftriaxone and High-concentration Intravenous Calcium Therapy in Adult Critical Care Patients: A Matched Cohort Study. Ann Pharmacother 2010; 44(7-8): 1158-63.
[9]	Rodríguez Rangel DA, Pinilla Orejarena AP, Bustacara Diaz M, Henao García L, López Cadena A, Montoya Camargo R, Moreno LA. Gallstones in association with the use of ceftriaxone in children. An Pediatr (Barc) 2014 ; 80(2): 77-80.
[10]	Nacaroglu HT, Demircin G, Bülbül M, Erdogan O, Akyüz SG, Caltik A. The association between urinary tract infection and idiopathic hypercalciuria in children. Ren Fail 2013; 35(3): 327-32.
[11]	Lozanovski VJ, Gucev Z, Avramoski VJ, Kirovski I, Makreski P, Tasic V. Ceftriaxone associated urolithiasis in a child with hypercalciuria. Hippokratia 2011; 15(2): 181-3.
[12]	Hernandez JD, Ellison JS, Lendvay TS. Current Trends, Evaluation, and Management of Pediatric Nephrolithiasis. JAMA Pediatr 2015; 169(10): 964-70.
[13]	Bartkowska-Śniatkowska A, Jończyk-Potoczna K, Zielińska M, Rosada-Kurasińska J. Adverse reaction to ceftriaxone in a 28-day-old infant undergoing urgent craniotomy due to epidural hematoma: review of neonatal biliary pseudolithiasis. Ther Clin Risk Manag 2015; 11: 1035-41.