Soysal Ahmet, Eraşov Kemal, Akpinar Ihsan, Bakir Mustafa
Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey.
Turk J Pediatr. 2007 Oct-Dec;49(4):404-7.
Ceftriaxone, a third-generation cephalosporin, is widely used for treating infection during childhood. It is mainly eliminated in the urine, but approximately 40% of a given dose is unmetabolized and secreted into bile. The aim of this study was to investigate the frequency, clinical characteristics, and outcome of biliary sludge (BS) in addition to potential contributing risk factors in children who receive ceftriaxone. Biliary ultrasonography was performed at the time of randomization before ceftriaxone treatment was started, on the 5th and 10th days, and at the end of the treatment. If BS was detected, patients were followed-up weekly by sonographic examination until the BS or biliary lithiasis (BL) disappeared. A total of 114 children (56 girls, 58 boys; age range: 2-180 months, mean 47.5 +/- 46.3 mos) were enrolled in the study. Fourteen (12%) subjects developed BS and 10 (9%) developed BL on the 5th day of treatment. On the 10th day of treatment, 20 (18%) subjects developed BS and 15 (13%) developed BL. In total, 35 (31%) of all subjects developed biliary precipitation (BP), of whom 20 (57%) were diagnosed as BS and 15 (43%) as BL. All subjects who developed BP were found to be asymptomatic during the course of therapy. Patient age over 12 months, daily total dose of ceftriaxone of more than 2 g, and duration of treatment longer than five days were found to be associated with BP. Ceftriaxone frequently causes transient BPs and its probability increases if the child is over 12 months of age, the dose is over 2 g/day, or the duration is over five days. Neither radiologic investigation nor the discontinuation of treatment with ceftriaxone is necessary as long as the patient is asymptomatic.
头孢曲松是一种第三代头孢菌素，广泛用于治疗儿童期感染。它主要通过尿液排出，但给定剂量中约40%未被代谢，而是分泌到胆汁中。本研究的目的是调查接受头孢曲松治疗的儿童中胆泥（BS）的发生率、临床特征和结局，以及潜在的危险因素。在开始头孢曲松治疗前随机分组时、治疗第5天和第10天以及治疗结束时进行腹部超声检查。如果检测到胆泥，对患者每周进行超声检查随访，直至胆泥或胆结石（BL）消失。共有114名儿童（56名女孩，58名男孩；年龄范围：2 - 180个月，平均47.5±46.3个月）纳入本研究。14名（12%）受试者在治疗第5天出现胆泥，10名（9%）出现胆结石。在治疗第10天，20名（18%）受试者出现胆泥，15名（13%）出现胆结石。总共35名（31%）受试者出现胆汁淤积（BP），其中20名（57%）被诊断为胆泥，15名（43%）为胆结石。所有出现胆汁淤积的受试者在治疗过程中均无症状。发现患者年龄超过12个月、头孢曲松每日总剂量超过2 g以及治疗持续时间超过5天与胆汁淤积有关。只要患者无症状，既无需进行影像学检查，也无需停用头孢曲松治疗。
