ro13-9904 and Bile-Duct-Diseases

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. In addition to biliary sludge formation occasional reports of ceftriaxone-induced nephrolithiasis have been published. In general, these adverse effects will develop after seven to ten days of treatment. We report on a seven-year-old boy with ceftriaxone-associated biliary pseudolithiasis and nephrolithiasis four days after initiation of treatment. Patients receiving a high dose of ceftriaxone and developing colicky abdominal pain should be considered for ultrasound and a change in antibiotic therapy if appropriate.

Topics: Bile Duct Diseases; Ceftriaxone; Cephalosporins; Child; Diagnosis, Differential; Humans; Kidney Calculi; Lithiasis; Male; Meningitis, Bacterial; Neisseria meningitidis

The treatment of biliary tract infections requires antibiotics and an appropriate surgical procedure. The aim of this study was to evaluate the efficacy and safety of piperacillin/tazobactam versus ceftriaxone plus ornidazole in the treatment of biliary tract infections.. This was a randomized, prospective and comparative clinical trial of two antibiotic regimens in the treatment of biliary tract infection. One hundred and fifty three patients were randomly allocated into two groups; three patients were excluded after randomization. One group (n = 75) received piperacillin/tazobactam (4 g/8 h iv) and the other group (n = 75) was administered a combination of ceftriaxone (2 g/24 h iv) plus ornidazole (1 g/24 h iv). In both groups, protocolized surgical or endoscopic procedures were carried out. Clinical efficacy and safety were assessed at the end of treatment.. Demographic data and severity of disease were similar in both groups. Three patients were excluded of the study by deviations from the protocol. Sixty-seven patients (89.3%) out of the piperacillin/tazobactam group and sixty-six patients (88%) out of the ceftriaxone plus ornidazole group were clinically cured (OR = 0.87 [95% CI, 0.31-2.4]). Twelve patients died, seven in the piperacillin/tazobactam group and five in the ceftriaxone plus ornidazole group. Adverse events were similar in both groups (OR = 1.18 [95% CI, 0.37-3.7]).. This study suggests that piperacillin/tazobactam is as efficacious and safe as ceftriaxone plus ornidazole in the treatment of biliary tract infections.

Topics: Aged; Anti-Bacterial Agents; Bile Duct Diseases; Ceftriaxone; Female; Humans; Infections; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prospective Studies

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. To examine this phenomenon further, serial gallbladder sonograms were evaluated in 44 adult patients who received intravenous ceftriaxone at 2 g or a placebo daily for 14 days in a double-blind controlled study. Ultrasound examinations of gallbladders were performed on days 1 and 14 of therapy and 2 weeks posttherapy if abnormalities were observed on day 14. Eight patients were unevaluable because of abnormal base-line gallbladder sonograms. Thirty-six patients (ceftriaxone, n = 28; placebo, n = 8) demonstrated normal baseline gallbladder sonograms and were evaluated for the development of change. A total of 6 of 28 (21.4%) ceftriaxone-treated patients and 1 of 8 (12.5%) patients who received the placebo demonstrated abnormal gallbladder sonograms on day 14 (P = 0.491). Four of the six ceftriaxone-treated patients demonstrating abnormal sonograms were clinically asymptomatic, while two patients reported vomiting. The abnormal sonograms of gallbladders of patients treated with ceftriaxone returned to normal between 9 and 26 days posttherapy. These data suggest an association between ceftriaxone treatment and the development of gallbladder abnormalities on ultrasound examination which resolve spontaneously on discontinuation of ceftriaxone therapy.

Topics: Adult; Bile Duct Diseases; Ceftriaxone; Cholelithiasis; Double-Blind Method; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Ultrasonography

The success of perioperative prophylaxis in gallbladder surgery was examined in two prospective randomized studies with a total of 326 patients. Postoperative wound-healing impairments did not occur in any of the patients receiving a single preoperative application of an antibiotic with a high biliary elimination rate (ceftriaxone or apalcillin). 11% of a control group without prophylactic antibiotic application evidenced infectious wound-healing disturbances.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Bile Duct Diseases; Ceftriaxone; Cholelithiasis; Double-Blind Method; Female; Humans; Male; Middle Aged; Naphthyridines; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Wound Healing

Topics: Aged; Anti-Bacterial Agents; Bile Duct Diseases; Ceftriaxone; Cholangiopancreatography, Magnetic Resonance; Diabetes Mellitus, Type 2; Diagnosis, Differential; Escherichia coli Infections; Hamartoma; Humans; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed; Ultrasonography

Topics: Aged, 80 and over; Anti-Infective Agents; Aza Compounds; Azithromycin; Bile Duct Diseases; Ceftriaxone; Fluoroquinolones; Humans; Male; Moxifloxacin; Quinolines; Syndrome

Ceftriaxone was approved in 1997 for the treatment of otitis media despite previous studies that documented an association of ceftriaxone with elevated hepato-biliary enzymes and transient biliary stasis. The case cited here highlights the need for continued awareness education for physicians who may use ceftriaxone to treat common illnesses such as acute exudative tonsillitis and otitis media in children. Specifically, for children with a family history of gallbladder, biliary tract, liver or pancreas dysfunction, ceftriaxone may not be the drug of choice since the likelihood of complications is increased in this population. Additionally, ceftriaxone may cause problems in either adults or children with preexisting disease, who may not be well-nourished, or who may be dehydrated.

Topics: Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Bile Duct Diseases; Ceftriaxone; Cephalosporins; Chemical and Drug Induced Liver Injury; Humans; Infant; Male; Otitis Media