Objective: Ceftriaxone is a third-generation cephalosporin which is widely used for treatment of infection in children accompanied by complications like urinary tract lithiasis and gallbladder psudolithiasis or sludge. The aim of this study was to investigate the incidence and predisposing factors that contribute to these complications in children.Methods: This quasi-experimental and before- and after-study was conducted in 96 children who were hospitalized for treatment of different bacterial infections and received 50-100 mg/kg/day ceftriaxone divided into two equal doses intravenously under conditions of adequate hydration. Sonographic examinations of urinary tract and gallbladder were carried out before and after treatment for that purpose. Patients with positive sonographic findings after treatment were followed with serial sonographic examinations.Findings: Post-treatment sonography demonstrated nephrolithiasis in 6 (6.3%) and gallbladder stone in one (1%), all were asymptomatic. Comparison of the groups with and without nephrolithiasis demonstrated no significant differences with respect to age, body weight, diagnosis, season of hospitalization, dosage of drug and the duration of treatment. Nephrolithiasis had a significant relation with male gender (P=0.02).Conclusion: Our results showed that pediatric patients may develop small sized, asymptomatic renal stones during a 2-6 day course of normal or moderate dose of ceftriaxone therapy. Close monitoring of ceftriaxone treated patients especially on high dose long term therapy for nephrolithiasis and gallbladder psudolithiasis or sludge is recommended.

Background: Ceftriaxone is almost widely used in the treatment of pediatric infection and this is accompanied by some complications.The aim of this study was to determine the incidence of abnormal ultrasonography finding of gallbladder (pseudolithiasis or sludge) during ceftriaxon therapy and its relation to fasting, sex and G6PD deficienty.Methods: This quasi-experimental survey was done in Amirkola Children's Hospital, Babol, Iran. First ultrasonography was done before initiation of ceftrixone therapy and it was repeated 24-48 hours after therapy and in the 5th ,7th, 10th and 14th day after the treatment. If abnormal finding was seen, ultrasonography was done weekly in the first two weeks until the side effect disappeared. Data was collected and analyzed by SPSS software. Findings: Of all 108 patients, who were between 3 months to 10 years old, 20 cases had abnormal finding in gallbladder (2 sludges and 18 pseudolithiases). Length of fasting before ceftriaxone therapy had a positive relation with possibility of stone formation (p<0.005), but age, sex, duration of therapy and G6PD deficiency were not related (p>0.05). In four cases pseudolithiasis was formed after only 1-2 dose of ceftriaxone. Shortest and longest periods of resolution of complications were 1 and17 days respectively after formation.Conclusion: Incidence of pseudolithiasis or sludge formation during ceftriaxone therapy was 18.5% and fasting had a great effect on these complications.

Biliary sludge or pseudolithiasis has been reported in patients who have received prolonged and/high doses of ceftriaxone. These are usually asymptomatic, but true bililary lithiasis is also rare. In general these adverse effects (sludge and pseudolithiasis) may develop even after seven to ten days of treatment that are usually asymptomatic. We report a six half-year old girl that was admitted to the hospital due to urinary tract infection. She had been treated with ceftriaxone for 14 days. She developed biliary colic due to biliary lithiasis after 14-day treatment. Ultrasonograghy has reported high level echo with posterior shadow in gal1bladder (true biliary stone). We recommend patients on prolonged and high doses of ceftriaxone and also those developing biliary colic should be considered for liver and gallbladder ultrasound and changes in antibiotic treatment if necessary.

Background and Objective: Considering the relatively wide application of ceftriaxone in pediatric infectious diseases and its side effects, this study was done to determine gallblader sonographic abnormality following ceftriaxone treatment in children.Materials and Methods: This descriptive cross- sectional study was carried out on 60 patients age 1 month up to 12 years in Besat hospital, Hamadan, Iran during 2007. The sonographic abnormal finding of gallbladder before ceftriaxone therapy and 5 days after therapy were recorded. In case of any abnormality in gallblader sonography was repeated twice a week in the first two weeks and afterward once a week up to disappearance of abnormalities.Results: Gallblader sonographic abnormality were observed in 10 cases (16.5%). Out of them, 8 and 2 patients had bile stone and bile sludge, respectivley. The patients did not show any clinical manifestations. There was no relation between age and sex with abnormal findings. Gallblader abnormality completely were disappeared in the worst cases by sixteen days.Conclusion: This study showed that the incidence of either gallstone or biliary sludge after treatment with ceftriaxone was 16.5% which is relatively similar to other studies.

Objective: Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. In this study we evaluated children with ceftriaxone associated seudolithiasis that was discovered incidentally in US examination. Material & Methods: The study includes 14 children with gallstones in Ultrasound without biliary symptoms with recent ceftriaxone administration. All of them were treated for suspected or definite bacterial infection with ceftriaxone 50-100mg/kg/day divided into 2 equal intravenous doses under conditions of adequate hydration. There were no other known underlying diseases for gallstone. Findings: Fourteen patients (11 boys and 3 girls) with mean age of 4.5 years (range: 2 months to 14 years) were studied. Following cessation of treatment with ceftriaxone, a complete resolution of the lithiasis was seen in most of followed cases. All patients were free from biliary symptoms (Right upper quadrant pain, Cholestasis) during observation. Consultations with surgeon or subspecialist due to reported "gallstone in the Ultrasound" were performed in about two-thirds of patients. Conclusion: Development of pseudolithiasis after ceftriaxone administration is not uncommon and should be known by pediatricians and radiologists in order to avoid unnecessary surgery or additional consultations.

Background: Ceftriaxone is an antibiotic used for treating respiratory, skin, bone and kidney infections. Our purpose was investigating effect of ceftriaxone on testicular tissue.Materials and Methods: 40 mice with 6 weeks old were used in this study. The mice randomly were divided into 2 groups, control- sham and test groups. The test group was subdivided to IP1 and IP2 which received Ceftriaxone with 20 mg/kgBW and 50 mg/kgBW dose for 45 days respectively. Testicular weight (TW), tubular diferentiation index (TDI), repopulation index (RI), thickness of testicular capsul (TTC), thickness of interistitial seminiferous tubuls (TIST), seminiferous diameter (SD) and number of leydig cells were evaluated.Results: Histological investigations in test groups revealed a significant reduction in percentage of leydig cells.Light microscopic showed atrophy of seminiferous tubuls.Ratio of spermatogonia B to A (TDI) decreased.TDI positive decreased in test group.Conclusion: these data revealed that ceftriaxone had adverse effect in testicular tissue.