Pharmacological treatment of ceftriaxone-related cholelithiasis in children: is it worthwhile?

Ceftriaxone treatment of bacterial infections can be associated with
biliary complications, more commonly in children than adults, in a dose-dependent
manner. This study describes a clinical case series of children with
ceftriaxone-related cholelithiasis.
We performed a retrospective analysis of cases of ceftriaxone-related
biliary complications admitted to the Pediatric Clinic, Department of Clinical
and Experimental Medicine, University of Sassari, Italy, during the period
2005-2015.
Four children with cholelithiasis occurring during, or soon after, the
treatment with ceftriaxone are reported. Case 1 (6-month-old), case 2 (9-year-old)
and case 4 (10-year-old) were symptomatic, while case 3 (3-year-old)
was asymptomatic. After the ultrasonographic diagnosis of gallstones
(cases 1 and 2) or biliary sludge (cases 3 and 4), ceftriaxone treatment was
withdrawn, and ursodeoxycholic acid (UDCA) was started in cases 1 and 2.
A complete recovery was observed in all but case 1, in whom cholelithiasis
was still detectable at one-year follow-up by ultrasonography. This case
underwent a triple antibiotic protocol for bacterial meningitis. The protocol
included rifampicin, which is known to have an effect in decreasing hepatic
concentration of bile salts. Therefore, in this case, both rifampicin and UDCA
were of no benefit in preventing or treating ceftriaxone biliary complications.
The current pharmacological approach for the treatment of ceftriaxone-related
cholelithiasis seems to be ineffective, likely due to the high calcium
content of gallstones. Therefore, the best strategy of intervention for
ceftriaxone biliary complications in children remains the prevention of the
risk factors.