gall bladder disease


Emergency Physicians should be aware of a side effect of ceftriaxone: biliary pseudolithiasis. Ceftriaxone-associated cholelithiasis is reversible and is thus called pseudolithiasis. Apart from stopping or converting the ceftriaxone treatment, no other therapy is indicated. Awareness of this phenomenon is important in preventing unnecessary surgery. This side effect is not described for other cephalosporins. Pseudolithiasis occurs because about 40% of ceftriaxone is secreted in the bile where an insoluble calcium-ceftriaxone complex is formed.

Pseudolithiasis as a result of ceftriaxone treatment is not rare. Most studies describe an incidence in the neighborhood of 25% and it is mostly described in the pediatric literature. Only a minority of patients will become symptomatic. Sonographic abnormalities are found 2 - 22 (mean, 9 days) days after initiation of ceftriaxone therapy and resolve spontaneously 2 - 63 (mean, 15 days) days after the end of ceftriaxone treatment. For this reason, besides stopping or converting the ceftriaxone therapy, no other treatment is recommended. Sonographically, the concretions seen in ceftriaxone pseudolithiasis are indistinguishable from typical gallstones.

Patients receiving ceftriaxone and developing colicky abdominal pain should be considered for ultrasound and a change in antibiotic if appropriate. Recognition of this complication will prevent unnecessary surgical interventions.

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(2) von Martels JZ, et al. Am J Emerg Med 2013;31(8):1294.e5-6.
(3) Zaki SA, et al. Indian J Pharmacol 2010; 42: 193-194.
(4) Kirejczyk WM, et al. Am J Roentgenol 1992;159: 329-30.

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