Ceftriaxone-associated gallbladder pseudolithiasis

Last revised by Daniel J Bell on 14 Feb 2024

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

Most patients are asymptomatic, although some may develop cholelithiasis, cholecystitis, cholangitis and/or pancreatitis 2,3

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

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.

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Cases and figures

  • Case 1
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  • Case 2
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