ro13-9904 and Cholecystitis

We report a case of a 35-year-old patient with acute pancreatitis after administration of ceftriaxone. She was given ceftriaxone (2g/day) for 9 days because of diverticulitis of the colon. She was admitted to our hospital again because of epigastralgia 12 days after the first administration of ceftriaxone. Laboratory examination showed markedly elevated serum amylase, and CT scan demonstrated findings consistent with acute pancreatitis, in addition to sludge in the common bile duct and gall bladder, which was not identified before the administration of ceftriaxone. We should be aware of the fact that administration of ceftriaxone sometimes results in the formation of biliary sludge and can cause severe adverse events such as cholecystitis and pancreatitis, not only in children, but also in adult patients.

Topics: Acute Disease; Adult; Ceftriaxone; Cholecystitis; Female; Humans; Pancreatitis

The combination of penicillin with an aminoglycoside has been recommended as an initial treatment of choice for patients with acute infections of the biliary tract. However, many patients have incidence of renal problems and for this reason aminoglycosides must be avoided. Newer antimicrobial agents with lesser nephrotoxic effects will be tried. We, therefore, performed a prospective, randomized trial of ofloxacin, a new quinolone and ceftriaxone in patients with acute biliary tract infections. Fifty-two patients with severe biliary tract infections (cholecystitis and cholangitis) were randomly assigned to receive either ofloxacin (n = 28) or ceftriaxone (n = 24). The 2 groups receiving antibiotics were similar with respect to all clinical and laboratory parameters. Bacteria were documented in 48% of patients in the ofloxacin group and in 46% in the ceftriaxone group. The percentage of patients with a clinical cure or significant improvement was the same in the 2 groups. No significant difference was noted between the 2 treatment groups with respect to drug toxicity. These data suggest that intravenous ofloxacin followed by oral administration is an effective and safe single drug for the therapy of patients with acute biliary tract infections.

Topics: Anti-Infective Agents; Bacteremia; Ceftriaxone; Cephalosporins; Cholangitis; Cholecystitis; Escherichia coli Infections; Female; Gram-Negative Bacterial Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Ofloxacin; Phlebitis

Forty patients with acute cholecystitis were divided into two randomized groups on the basis of the emergency antimicrobial therapy received, and were treated for a period of 5 days. The first group was given ceftriaxone (Rocephin), the second cefoperazone (Cefobis). This concomitant antimicrobial treatment of acute cholecystitis proved to be effective in 85% of the patients; 15% underwent 'à chaud' surgery on the 6th day because of a lack of response to the treatment. Ceftriaxone and cefoperazone proved to be equally effective. Use of ceftriaxone, however, was simpler (one injection a day) and the cost of treatment substantially lower.

Topics: Adult; Aged; Aged, 80 and over; Cefoperazone; Ceftriaxone; Cholecystitis; Female; Humans; Infusions, Intravenous; Male; Middle Aged

Biliary pseudolithiasis is a ceftriaxone (CTRX)-induced complication, but the risk in cases of elderly type 1 diabetes mellitus (T1DM) is unclear. Case 1: A 78-year-old woman with T1DM complicated by diabetic autonomic neuropathy was admitted with pneumonia and treated with CTRX. On day 8, biliary pseudolithiasis and cholecystitis were observed. Case 2: an 80-year-old woman with T1DM was suspected of having a urinary tract infection and treated with CTRX. After a week, she developed asymptomatic biliary pseudolithiasis with gastroparesis. CTRX-associated biliary pseudolithiasis was thus noted in these cases of elderly T1DM. CTRX should be cautiously administered, especially in elderly T1DM patients with diabetic autonomic neuropathy.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Cholecystitis; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Female; Humans

Topics: Administration, Intravenous; Anti-Bacterial Agents; Ceftriaxone; Cholecystectomy; Cholecystitis; Gallbladder; Humans; Male; Situs Inversus; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Young Adult

Topics: Aged; Anti-Bacterial Agents; Bile; Ceftriaxone; Chemical Precipitation; Cholecystitis; Diabetes Mellitus; Humans; Male; Pneumococcal Infections

Salmonella cholecystitis is a rare but important complication of Salmonella typhi infection. We are reporting an 11 years old female child who presented with complaints of high-grade fever, jaundice and right sided abdominal pain (Charcot's triad). Her examination showed tender hepatomegaly. Initial blood results revealed high white cell counts with left shift, deranged liver function tests. Abdominal ultrasonography revealed distended gallbladder with minimal layer of sludge seen within its lumen along with streak of pericholecystic fluid. Blood culture grew Salmonella typhi. She was successfully treated with intravenous ceftriaxone.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Cholecystitis; Female; Gallbladder; Hepatomegaly; Humans; Liver Function Tests; Salmonella Infections; Salmonella typhi; Treatment Outcome; Typhoid Fever; Ultrasonography

Candidiasis of the gallbladder is an uncommon cause of acute cholecystitis. Candidal cholecystitis is seen especially in patients with malignancies. In the present case, we report that acute calculous cholecystitis was caused by Candida lusitaniae in a 33-year-old patient without underlying malignancy. According to our review of the literature, this is the first report of acute cholecystitis caused by C. lusitaniae.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis; Ceftriaxone; Cholecystitis; Female; Fluconazole; Gallbladder; Gallstones; Humans

Drug related false-positive hepatobiliary imaging is uncommon. The authors present a case of a 54-year-old woman who was treated with intravenous ceftriaxone for bacterial meningitis. Symptoms of acute cholecystitis subsequently developed and a sonogram revealed a gallstone. A Tc-99m DISIDA hepatobiliary study was positive for cystic duct obstruction. After discontinuation of ceftriaxone, the patient's clinical condition improved and, 2 weeks later, a repeat hepatobiliary scan was normal. High doses of ceftriaxone and prolonged administration may lead to formation of pseudocholelithiasis and signs of acute cholecystitis. Although this condition is usually benign and reversible, discontinuation of the drug is warranted when symptoms of acute cholecystitis are accompanied by a positive hepatobiliary scan.

Topics: Ceftriaxone; Cephalosporins; Cholecystitis; Cholelithiasis; False Positive Reactions; Female; Gallbladder; Humans; Imino Acids; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Treatment of unsubstantiated Lyme disease has led to serious complications in some cases. Two case-control studies, based on information in clinical records of patients discharged with a diagnosis of Lyme disease during 1990-1992, were conducted at a central New Jersey hospital. Twenty-five patients with biliary disease were identified, and 52 controls were selected from 1352 patients with suspected Lyme disease. Only 3% of 71 evaluatable subjects met the study criteria for disseminated Lyme disease. Patients with biliary disease were more likely than were antibiotic controls to have received ceftriaxone and more likely than ceftriaxone controls to have received a daily ceftriaxone dose > or = 40 mg/kg and to be < or = 18 years old. Fourteen of 25 biliary case-patients underwent cholecystectomy; all had histopathologic evidence of cholecystitis and 12 had gallstones. Thus, treatment of unsubstantiated diagnoses of Lyme disease is associated with biliary complications.

Topics: Adolescent; Adult; Age Factors; Case-Control Studies; Ceftriaxone; Child; Child, Preschool; Cholecystitis; Cholelithiasis; Female; Humans; Lyme Disease; Male; Middle Aged; New Jersey; Retrospective Studies; Risk Factors; Sex Factors

A rare case of acute acalculous cholecystitis caused by Salmonella typhi in a 6-year-old child is presented. The clinical signs were fulminant, with diffuse peritonitis being suspected. Cholecystostomy and i.v. ceftriaxone proved efficacious and the girl was discharged in less than two weeks. The appropriate literature is reviewed.

Topics: Ceftriaxone; Child; Cholecystitis; Cholecystostomy; Female; Humans; Salmonella typhi; Typhoid Fever

The penetration of ceftriaxone and cefoperazone into bile and gallbladder tissue was prospectively studied in 21 adult patients undergoing early surgery for acute cholecystitis. Comparable tissue, bile, and serum concentrations of the drugs were demonstrable; however, significantly fewer preoperative doses of ceftriaxone were required for adequate perioperative treatment. In view of its higher serum half-life and superior antibacterial activity toward common biliary pathogens, ceftriaxone appears to be a useful drug for the perioperative management of acute cholecystitis.

Topics: Acute Disease; Aged; Aged, 80 and over; Bile; Cefoperazone; Ceftriaxone; Cholecystectomy; Cholecystitis; Combined Modality Therapy; Drug Evaluation; Female; Gallbladder; Humans; Male; Middle Aged; Postoperative Care; Premedication; Prospective Studies

To evaluate the effects of ceftriaxone (CTRX) administered once daily, the biliary concentration of CTRX and daily changes in the bacterial count in bile from an indwelling T-tube were measured concomitantly. The effects on prophylaxis of postoperative infections after biliary tract surgery were also examined mainly due to clinical symptoms. The biliary CTRX levels increased rapidly and were sustained as high as 92.5-219 micrograms/ml in all patients even 24 hours after 2 g of CTRX was infused intravenously once daily. Five of 7 patients whose bile samples were positive for bacteria showed high CTRX levels in bile and almost no bacteria present after treatment. CTRX-sensitive bacteria eliminated 1 or 2 hours after the administration in response to the increase of biliary CTRX levels. The changes in bacteria count of bile may be closely related to CTRX antibiotic activity. As an antibiotic prophylaxis, other 18 patients with biliary diseases received intravenous infusion of 2 g of CTRX once daily for 5-7 days (mean 5.9 days). Thus, once-daily dose treatment of CTRX 2 g may have antibiotic effects on biliary infection and postoperative prophylaxis of biliary infections and it is indicated that the prolonged biliary levels of CTRX are essential for its efficacy.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Bile; Ceftriaxone; Cholecystitis; Colony Count, Microbial; Drug Evaluation; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication

Topics: Acute Disease; Adolescent; Arthritis, Infectious; Ceftriaxone; Cholecystitis; Female; Humans; Osteochondritis; Pseudomonas Infections; Tobramycin; Ultrasonography