Ceftriaxone-associated gallbladder pseudolithiasis
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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 precipitate with calcium, resulting in the formation of a ceftriaxone-calcium complex 2,3.
Other drugs have also been implicated as causes of pseudolithiasis including furosemide, clofibrate, octreotide, cyclosporine, erythromycin, and ampicillin 4.
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.