Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children

J Clin Ultrasound. 2000 May;28(4):166-8. doi: 10.1002/(sici)1097-0096(200005)28:4<166::aid-jcu2>;2-g.


Purpose: Ceftriaxone is a widely used third-generation cephalosporin. In this prospective study, we used sonography to investigate the incidence and outcome of biliary complications in children receiving ceftriaxone therapy.

Methods: Ceftriaxone was administered intravenously at a dosage of 100 mg/kg/day for 1-3 weeks to 118 children hospitalized for severe infection. Serial gallbladder sonograms were obtained on days 1, 5-7, and 10-14 of therapy and the day after therapy ended if it had lasted more than 2 weeks. When sonographic abnormalities were found, additional sonograms were obtained every 3 days until the abnormalities had completely resolved.

Results: Twenty patients (17%), all asymptomatic, demonstrated sonographic abnormalities: 8 had gallbladder sludge, defined as echogenic material without associated acoustic shadowing, and 12 had pseudolithiasis, defined as echogenic material with acoustic shadowing. These abnormalities spontaneously resolved within 2 weeks of stopping the ceftriaxone (mean time to disappearance, 8.2 +/- 3.4 days). No significant differences were found between patients with normal versus abnormal sonographic findings in sex, age, duration of treatment, or other risk factors for drug precipitation.

Conclusions: Ceftriaxone-associated biliary pseudolithiasis is usually asymptomatic and was rapidly reversible after cessation of therapy in this group of Turkish children.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Adolescent
  • Ceftriaxone / adverse effects*
  • Chemical Precipitation
  • Child
  • Child, Preschool
  • Cholelithiasis / chemically induced*
  • Cholelithiasis / diagnostic imaging*
  • Cholelithiasis / epidemiology
  • Female
  • Gallbladder / diagnostic imaging
  • Humans
  • Incidence
  • Infant
  • Male
  • Prospective Studies
  • Remission, Spontaneous
  • Ultrasonography


  • Ceftriaxone