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Biliary Sludge and Hyperbilirubinemia Associated with Ceftriaxone in an Adult: Case Report and Review of the Literature
Author(s) -
Bickford Courtney L.,
Spencer Anne P.
Publication year - 2005
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.2005.25.10.1389
Subject(s) - ceftriaxone , medicine , biliary sludge , cholecystitis , antibiotics , cephalosporin , jaundice , bilirubin , liver function , liver function tests , gastroenterology , surgery , gallbladder , microbiology and biotechnology , biology
Ceftriaxone is a commonly used third‐generation cephalosporin that has antimicrobial activity against many gram‐positive and gram‐negative organisms. Generally, ceftriaxone is a safe antibiotic; however, symptomatic biliary sludge has been reported in rare instances, most of which have involved children. It is uncommon for ceftriaxone to cause increases in laboratory indexes, such as bilirubin levels. We describe the case of a 53‐year‐old man who was treated with intravenous ceftriaxone 2 g every 12 hours. After 7 days of therapy, the patient's liver function test results, including total, direct, and indirect bilirubin levels, increased significantly from baseline, and the patient became jaundiced. A right upper quadrant ultrasound examination revealed biliary sludge and cholelithiasis without sonographic evidence of cholecystitis. Ceftriaxone was thought to be the responsible agent, and it was discontinued. The patient's jaundice subsided, and his liver function test results improved, returning to baseline within 14 days. Clinicians need to be aware of the association of ceftriaxone and biliary pseudolithiasis and hyperbilirubinemia, and monitor accordingly.