Sık seftriakson kullanımı ve safra kesesi taşı: yedi olgunun sunumu Türkçe

Yıl 2012, Cilt: 9 Sayı: 3, 145 - 149, 01.12.2012

Mahmut Abuhandan Ekrem Karakaş Hasan Çeçe Ömer Karakaş Alpay Çakmak

Öz

Seftriakson, birçok enfeksiyon hastalığının tedavisinde parenteral yoldan kullanılan, güçlü antimikrobiyal etkiye sahip, üçüncü kuşak sefalosporinler grubundan bir antibiyotiktir. Seftriakson kullanımına bağlı olarak safra kesesi lümeninde oluşan, genellikle semptoma yol açmadan spontan olarak kaybolan, safra kesesinde geçici taş ya da çamur oluşumu psödolitiyazis olarak adlandırılır. Zaman içerisinde, psödolitiyazisin kimyasal yapısına, oluşum ve kaybolma sürecine etki eden faktörleri, radyolojik seyrini ele alan klinik ve deneysel çalışmalar yapılmıştır Bu çalışmada 3'ten fazla en az beş gün intramüsküler seftriakson tedavisi alan ve buna bağlı safra kesesi taşı oluşan 7 hasta alındı. Haftalık ultrasonografik izlemler ile takip edilen hastaların safra kesesi taşların 3-6 hafta içinde kendiliğinden kaybolduğu görüldü. Sonuç olarak seftriakson verilen hastalarda gelişen safra kesesi taşı beklenen bir komplikasyondur ve tedavisiz kendiliğinden düzelmekte olup; hastalara gereksiz ilaç ve cerrahi müdahalelerden kaçınılması gerektiğini vurgulamak istedik

Anahtar Kelimeler

Çocuk, seftriakson, psödolitiyazis

Frequent use of ceftriaxone and gallbladder stone: report of 7 cases

Öz

Ceftriaxone is a third-generation cephalosporin antibiotic with potent antimicrobial activity, which is parenterally administered in the treatment of numerous infectious diseases. Transient formation of stone or sludge within gallbladder, which develops in the gallbladder lumen depending on the use of ceftriaxone and usually disappears spontaneously without causing any symptoms, is named pseudolithiasis. There have been clinical and experimental studies conducted in time, which addressed the chemical mechanism of pseudolithiasis, factors affecting its formation and disappearance, and its radiological progress. In this study, 7 patients were enrolled, who received intramuscular treatment of ceftriaxone more than 3 times for at least five days and hence developed gallstones. Gallstones of patients, who were followed-up with weekly ultrasonographic examinations, were observed to have spontaneously vanished within 3-6 weeks. To conclude, we intended to emphasize that gallstone formation developed in patients receiving ceftriaxone is an anticipated complication and resolves spontaneously without any treatments, and thus that any unnecessary medications and surgical interventions should be avoided

Anahtar Kelimeler

Child, ceftriaxone, pseudolithiasis

Kaynakça

• ) Palasciano G, Portincasa P, Vinciguerra V, et al. Gallstone prevalence and gallbladder volume in children and adolescents: an epidemiological ultrasonography survey and relationship to body mass index. Am J Gastroenterol 1989; 84: 1378-82.
• ) Gilger MA. Diseases of the gallbladder. In: Wyllie R, Hyams JS (eds). Pediatric Gastrointestinal Disease. 2. ed. Philedelphia: W.B Sounders Company, 1999; 651-62.
• ) Riccabona M, Kerbl R, Schwinger W, et al. Ceftriaxone-induced cholelithiasis-a harmless side- effect? Klin Pediatr 1993; 205: 421–3.
• ) 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: 141–7.
• ) Blais C, Duperval R. Biliary pseudolithiasis in a child associated with 2 days of ceftriaxone therapy. Pediatr Radiol 1994; 24: 218–9.
• ) Park HZ, Lee SP, Schy AL. Ceftriaxone- associated gallbladder sludge. Identification of calcium-ceftriaxone salt as a major component of gallbladder precipitate. Gastroenterology 1991; : 1665–70.
• ) Schaad UB, Tschappeler H, Lentze MJ. Transient formation of precipitations in the gallbladder associated with ceftriaxone therapy. Pediatr Infect Dis 1986; 5: 708–10.
• ) Ceylan H, Sivaslı E, Coşkun Y. Safra kesesi psödolitiyazisi, seftriaksonun sık ve gözden kaçan bir yan etkisi: iki vakanın takdimi. Çocuk sağlığı ve Hastalıkları Dergisi 2002; 45: 61–4.
• ) Palanduz A, Yalcin I, Tonguc E, et al. Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children. J Clin Ultrasound ; 28: 166–8. ) 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: 368–71.
• ) Papadopoulou F, Efremidis S, Karyda S, et al. Incidence of ceftriaxone-associated gallbladder pseudolithiasis. Acta Paediatr 1999; 88: 1352–5.
• ) Bakkaloglu A, Saatci U, Soylemezoglu O, et al. Comparison of ceftriaxone versus cefotaxime for childhood upper urinary tract infections. J Chemother ; 8: 59–62. ) Zhong XH, Chen H,Yao Y, et al. Reversible ceftraxone-associated biliary pseudolithiasis in three children with renal diseases. Zhonghua Er Ke Za Zhi ; 48: 216-9. ) Kong MS, Chen CY. Risk factors leading to ceftriaxoneassociated biliary pseudolithiasis in children. Changgeng Yi Xue Za Zhi 1996; 19: 50–4.
• ) Shiffman ML, Keith FB, Moore EW. Pathogenesis of ceftriaxone-associated biliary sludge. In vitro studies of calcium-ceftriaxone binding and solubility. Gastroenterology 1990; 99: 1772–8.
• ) Schaad UB, Wedgwood-Krucko J, Tschaeppeler H. Reversible ceftriaxone-associated biliary pseudolithiasis in children. Lancet 1988; 17: 1411–3.
• ) Zinberg J, Chernaik R, Coman E, et al. Reversible symptomatic biliary obstruction associated with ceftriaxone pseudolithiasis. Am J Gastroenterol 1991; 9: 1251-4.
• ) Göktan C, Tarhan S, Can M, et al. Psödolitiyazis. Turk J Radiol 1999; 34: 230-2.
• ) Pigrau C, Pahissa A, Gropper S, et al. Ceftriaxone-associated biliary pseudolithiasis in adults. Lancet 1989; 2: 165.
• ) Tünger O, Dinç G, Özbakkaloğlu B, Atman UC, Algun U: Evaluation of rational antibiotic use. Int. J Antimicrob Agents 2000; 15: 131-5.
• ) Çakır N: Rasyonel olmayan antibiyotik kullanımının ekonomik sonuçları. Klimik Derg 2001; : 35-40.