Cálculos biliares asociados al uso de ceftriaxona en niños / Gallstones in association with the use of ceftriaxone in children

INTRODUCCIÓN: La pseudocolelitiasis asociada a ceftriaxona en niños es un evento frecuente pero pocas veces tenido en cuenta; ocurre en el 15 al 57% de los que la reciben y en la mayoría de los casos cursa asintomática y autorresolutiva. PACIENTES Y MÉTODOS: Estudio prospectivo, observacional y descriptivo. Se incluyeron pacientes de 1 mes a 18 años que recibieron ceftriaxona. Se realizó ecografía de hígado y vesícula biliar al inicio del tratamiento y cada 5 días hasta finalizarlo. A los pacientes con anormalidades ecográficas se les realizó seguimiento clínico y ecográfico semanalmente hasta la resolución completa. Se buscó asociación con los factores de riesgo descritos en la literatura. RESULTADOS: Fueron incluidos 73 pacientes, 57,5% femeninos, con edad entre 4 meses y 17 años (x = 4,2 años). Se presentó pseudocolelitiasis en 31 pacientes (42,5%) y en este grupo se documentó al día 5 en el 96,8% (n = 30). El tamaño de los cálculos estuvo entre 4 y 14 mm (x = 8,1). La duración de la pseudocolelitiasis estuvo entre 9 y 55 días (x = 24,1 días). El 22,6% (n = 7) presentó síntomas y se presentó una complicación grave. En el análisis multivariado el lactato de Ringer como líquido de dilución tuvo 1,86 veces más riesgo (p = 0,019). No se encontró relación con la edad, duración ni dosis del antibiótico, ayuno, uso de suplementos de calcio, nutrición parenteral o uso de otros antibióticos. CONCLUSIÓN: Se presenta pseudocolelitiasis asociado a ceftriaxona en 4 de cada 10 niños que la reciben, sin relación con factores de riesgo tradicionales. La evolución es hacia la auto resolución aunque cerca del 20% presentan síntomas

INTRODUCTION: Ceftriaxone associated pseudolithiasis is fairly frequent in children, but rarely taken into account. It occurs in 15% to 57% of children, and in most cases is asymptomatic and resolves spontaneously. PATIENTS AND METHODS: A prospective, observational, and descriptive study was conducted that included patients aged 1 month to 18 years-old who received ceftriaxone. Liver and gallbladder ultrasound was performed at the start of treatment, and every 5 days until it was completed. Patients with abnormal ultrasound findings were followed up clinically every week until they were resolved. The findings were compared with risk factors described in the literature. RESULTS: A total of 73 patients aged between 4 months and 17 years (mean = 4.2 years) were included, of whom 57.5% were female. Pseudolithiasis was present in 31 patients (42.5%) and was documented in 96.8% (n = 30) of this group on day 5. The stone size was between 4 and 14 mm (mean = 8.1 mm). The duration of pseudolithiasis was between 9 and 55 days (mean = 24.1 days).Symptoms were present in 22.6% (n = 7) and 1 had a serious complication. In the multivariate analysis, Ringer's Lactate as fluid dilution was 1.86 times higher risk (P = 0.019). No relationship was found with age, duration and dose of antibiotic, fasting, use of calcium supplements, parenteral nutrition, or use of other antibiotics. CONCLUSION: Pseudocolelitiasis associated with ceftriaxone take place in 4 of 10 children who receive, unrelated to traditional risk factors. The trend is towards self resolution although about20% have symptoms

[Gallstones in association with the use of ceftriaxone in children]. / Cálculos biliares asociados al uso de ceftriaxona en niños.

INTRODUCTION: Ceftriaxone associated pseudolithiasis is fairly frequent in children, but rarely taken into account. It occurs in 15% to 57% of children, and in most cases is asymptomatic and resolves spontaneously. PATIENTS AND METHODS: A prospective, observational, and descriptive study was conducted that included patients aged 1 month to 18 years-old who received ceftriaxone. Liver and gallbladder ultrasound was performed at the start of treatment, and every 5 days until it was completed. Patients with abnormal ultrasound findings were followed up clinically every week until they were resolved. The findings were compared with risk factors described in the literature. RESULTS: A total of 73 patients aged between 4 months and 17 years (mean=4.2 years) were included, of whom 57.5% were female. Pseudolithiasis was present in 31 patients (42.5%) and was documented in 96.8% (n=30) of this group on day 5. The stone size was between 4 and 14mm (mean=8.1mm). The duration of pseudolithiasis was between 9 and 55 days (mean=24.1 days). Symptoms were present in 22.6% (n=7) and 1 had a serious complication. In the multivariate analysis, Ringer's Lactate as fluid dilution was 1.86 times higher risk (P=.019). No relationship was found with age, duration and dose of antibiotic, fasting, use of calcium supplements, parenteral nutrition, or use of other antibiotics. CONCLUSION: Pseudocolelitiasis associated with ceftriaxone take place in 4 of 10 children who receive, unrelated to traditional risk factors. The trend is towards self resolution although about 20% have symptoms.