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Ceftriaxone
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Baek-Nam Kim, Anna Maria Peri, David L. Paterson
The manufacturer reports biliary pseudolithiasis (gallbladder sludge) as a rare adverse reaction (< 0.1%) (Roche, 2015). However, studies assessing for pseudolithiasis have reported a frequency as high as 25–46% (Schaad et al., 1986; Pigrau et al., 1989; Schaad et al., 1990; Papadopoulou et al., 1999). Biliary pseudolithiasis, diagnosed by sonography, developed 2–22 days after initiation of ceftriaxone therapy (Schaad et al., 1986; Pigrau et al., 1989; Papadopoulou et al., 1999). The mean time to onset of detectable pseudolithiasis was 9 days in the studies with children and adults (Schaad et al., 1986; Pigrau et al., 1989; Palanduz et al., 2000). The majority of cases are usually asymptomatic and reversible and require only conservative management (Schaad et al., 1988; Papadopoulou et al., 1999), but up to one third (0–33%) of patients with sonographic evidence of biliary pseudolithiasis developed symptoms (Schaad et al., 1988; Pigrau et al., 1989; Cometta et al., 1990; Heim-Duthoy et al., 1990; Schaad et al., 1990; Palanduz et al., 2000). Biliary pseudolithiasis completely resolved in all patients 2 days to 3 months after cessation of ceftriaxone therapy (Schaad et al., 1986; Schaad et al., 1988; Pigrau et al., 1989; Cometta et al., 1990; Heim-Duthoy et al., 1990; Schaad et al., 1990; Kirejczyk et al., 1992; Papadopoulou et al., 1999). Pancreatitis has also been reported as a complication of ceftriaxone biliary sludge (Zimmermann et al., 1993).
Treatment options for neonatal infections in the post-cefotaxime era
Published in Expert Review of Anti-infective Therapy, 2022
Susannah Franco, Daniel Rampersad, Daniel Mesa, Margaret R. Hammerschlag
Ceftriaxone is 85–95% protein bound and competes with bilirubin for albumin binding, displacing bilirubin and increasing levels of free bilirubin [18]. Additionally, 40–45% is excreted unmetabolized by the gallbladder into the bile [16,19]. Ceftazidime and cefepime clearance depend on glomerular filtration rate and serum creatinine, respectively, and thus they are not considered to accumulate in the bile [12]. Cefotaxime is excreted by the gall bladder to a similar extent as ceftriaxone, but it is only about 40% protein-bound [19]. A prospective study in children greater than 2 months of age has shown increased biliary sludge and biliary pseudolithiasis with ceftriaxone versus cefotaxime (20.9% versus 5.9%); all cases were asymptomatic and uncomplicated [19]. Interestingly, children over 4.5 years old were at a higher risk of developing biliary sludge or cholelithiasis, which has been echoed by other reports [19,20].