Seftriakson Tedavisine Bağlı Safra Taşı ve Safra Çamuru

Year 2005, Volume: 22 Issue: 4, 151 - 155, 31.12.2009

A. G. Kalaycı F. Demir Ü. Belet

Abstract

Seftriakson, enfeksiyon tedavisinde sık kullanılan üçüncü kuşak sefalosporindir. Safra kesesinde geçici taş ya da çamur oluşumu psödolitiyazis olarak adlandırılır. Seftriaksona bağlı psödolitiyazis olgularının çoğunun bulgu vermemesi nedeniyle seftriakson tedavisi alan hastalarda psödolitiyazis sıklığını ve seyrini belirlemek amacıyla bir pilot çalışma yaptık. Bakteriyel menenjit ve pnömoni nedeniyle hastaneye yatırılan ve 100 mg/kg/gün dozunda seftriakson tedavisi alan 13 hasta çalışmaya alındı. Tedavi öncesi ve tedavinin onuncu günü ultrasonografik inceleme yapıldı. Safra çamuru veya taş saptanan hastalarda tedavi kesildikten sonra bir hafta aralarla ultrasonografik inceleme tekrarlandı. Başlangıçta ultrasonografik inceleme bulguları normaldi. Tedavinin 10. gününde dört hastada (%31) psödolitiyazis saptandı. Olguların üçünde safra taşı, birinde safra çamuru ile birlikte taş görüntülendi. Bu olguların hiçbirinde bulgu olmamasına rağmen seftriakson tedavisi kesildi. Yapılan ultrasonografik izlemde tedavi kesildikten 22-45 gün sonra psödolitiyazisin kaybolduğu görüldü. Sonuç olarak seftriakson verilen hastalarda psödolitiyazis beklenen bir komplikas-yondur ve tedavi kesildikten sonra kendiliğinden düzelmektedir.


Gallbladder Stone or Sludge Related to Ceftriaxone Treatment

Ceftriaxone is a widely used third generation cephalosporin. Transient gallbladder stone or sludge formation called pseudolithiasis. We planned a pilot study, to evaluate the incidence of gallbladder pseudolithiasis in children treated with ceftriaxone as most of the ceftriaxone induced pseudolithiasis cases are asymptomatic. In this study 13 children treated with ceftriaxone (100 mg/kg/day) for pneumonia and meningitis were examined. Each study patient had ultrasound examinations of gallbladder at the beginning and tenth day of the ceftriaxone treatment. If any abnormality was detected, scanning was repeated weekly after the end of the ceftriaxone treatment. All of the initial ultrasonographic examinations were normal. Pseudolithiasis was detected in four (%31) of the patients at the tenth day of ceftriaxone the rapy, 3 had gallstones and 1 had gallstone together with sludge. Although all patients were asymptomatic, ceftriaxone treatment was discontinued. Pseudolithiasis completely resolved in 22-45 days after the end of the treatment. As a result pseudolithiasis is an expected complication of ceftriaxone treatment, it resolves spontaneously after the treatment.

Keywords

-

References

• Arvidsson A, Alvan G, Angelin B, et al. Ceftriaxone: renal and biliary excretion and effect on the colon microflora. J Antimicrob Chemother 1982; 10: 207–215.
• Lee SP, Lipsky BA, Teefey SA. Gallbladder sludge and antibiotics. Pediatr Infect Dis J 1990; 9: 422–423.
• Riccabona M, Kerbl R, Schwinger W, et al. Ceftriaxone-induced cholelithiasis-a harmless s i d e - e f f e c t ? Klin Pediatr 1993; 205: 421–423.
• Schaad UB, Suter S, Gianella-Borradori A, et al. A comparison of ceftriaxone and cefuroxime for the treatment of bacterial meningitis in children. N Engl J Med 1990; 322: 141–147.
• Blais C, Duperval R. Biliary pseudolithiasis in a child associated with 2 days of ceftriaxone therapy. Pediatr Radiol 1994; 24: 218–219.
• Park HZ, Lee SP, Schy AL. Ceftriaxone-associated gallbladder sludge. Identification of calcium-ceftriaxone salt as a major component of gallbladder precipitate. Gastroenterology 1991; 100: 1665–1670.
• Schaad UB, Tschappeler H, Lentze MJ. Transient formation of precipitations in the gallbladder associated with ceftriaxone therapy. Pediatr Infect Dis 1986; 5: 708–710.
• Ceylan H, Sivasl› E, Coflkun Y. Safra kesesi psödolitiyazisi, seftriaksonun s›k ve gözden kaçan bir yan etkisi: iki vakan›n takdimi. Çocuk Sa¤l›¤› ve Hastal›klar› Dergisi 2002; 45: 61–64.
• Palanduz A, Yalcin I, Tonguc E, et al. Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children. J Clin Ultrasound 2000; 28: 166–168.
• Bonnet JP, Abid L, Dabhar A, et al. Early biliary pseudolithiasis during ceftriaxone therapy for acute pyelonephritis in children: a prospective study in 34 children. Eur J Pediatr Surg 2000; 10: 368–371.
• Papadopoulou F, Efremidis S, Karyda S, et al. Incidence of ceftriaxone-associated gallbladder pseudolithiasis. Acta Paediatr 1999; 88: 1352–1355.
• Bakkaloglu A, Saatci U, Soylemezoglu O, et al. Comparison of ceftriaxone versus cefotaxime for childhood upper urinary tract infections. J Chemother 1996; 8: 59–62.
• Richards DM, Heel RC, Brogden RN, et al. Ceftriaxone. A review of its antibacterial activity, pharmacological properties and therapeutic use. Drugs 1984; 27: 469: 527.
• Kirejczyk WM, Crowe HM, Mackay IM, et al. Disappearing “gallstones”: Biliary pseudolithiasis complicating ceftriaxone therapy. AJR 1992; 159: 329–330.
• Kong MS, Chen CY. Risk factors leading to ceftriaxoneassociated biliary pseudolithiasis in children. Changgeng Yi Xue Za Zhi 1996; 19: 50–54.
• Shiffman ML, Keith FB, Moore EW. Pathogenesis of ceftriaxone-associated biliary sludge. In vitro studies of calcium-ceftriaxone binding and solubility. Gastroenterology 1990; 99: 1772–1778.
• Schaad UB, Wedgwood-Krucko J, Tschaeppeler H. Reversible ceftriaxone-associated biliary pseudolithiasis in children. Lancet 1988; 17: 1411–1413