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Mitochondrial Side Effects of Surgical Prophylactic Antibiotics Ceftriaxone and Rifaximin Lead to Bowel Mucosal Damage. Int J Mol Sci 2022; 23:ijms23095064. [PMID: 35563455 PMCID: PMC9103148 DOI: 10.3390/ijms23095064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 02/04/2023] Open
Abstract
Despite their clinical effectiveness, a growing body of evidence has shown that many classes of antibiotics lead to mitochondrial dysfunction. Ceftriaxone and Rifaximin are first choice perioperative antibiotics in gastrointestinal surgery targeting fundamental processes of intestinal bacteria; however, may also have negative consequences for the host cells. In this study, we investigated their direct effect on mitochondrial functions in vitro, together with their impact on ileum, colon and liver tissue. Additionally, their impact on the gastrointestinal microbiome was studied in vivo, in a rat model. Rifaximin significantly impaired the oxidative phosphorylation capacity (OxPhos) and leak respiration in the ileal mucosa, in line with increased oxidative tissue damage and histological changes following treatment. Ceftriaxone prophylaxis led to similar changes in the colon mucosa. The composition and diversity of bacterial communities differed extensively in response to antibiotic pre-treatment. However, the relative abundances of the toxin producing species were not increased. We have confirmed the harmful effects of prophylactic doses of Rifaximin and Ceftriaxone on the intestinal mucosa and that these effects were related to the mitochondrial dysfunction. These experiments raise awareness of mitochondrial side effects of these antibiotics that may be of clinical importance when evaluating their adverse effects on bowel mucosa.
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Kajiwara T, Ariga H, Kashimura J. Ceftriaxone pseudolithiasis detected by computed tomography and followed up until resolution. J Rural Med 2020; 15:230-233. [PMID: 33033548 PMCID: PMC7530589 DOI: 10.2185/jrm.2020-020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/11/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction: Ceftriaxone is a third-generation cephalosporin antibiotic
that has been widely used to treat various infectious diseases. We report a case of
ceftriaxone pseudolithiasis that was detected by computed tomography (CT) and followed up
until it was resolved. Case: A 76-year-old woman with diabetes mellitus and renal impairment, but
no history of gallstones, was diagnosed with septic shock due to renal and lung abscesses
and treated with ceftriaxone. On day 22 after admission, abdominal CT revealed a
gallstone, which increased in size up to day 50. Ceftriaxone was stopped on day 50, and
the gallstone resolved completely after 10 weeks. Conclusion: Ceftriaxone pseudolithiasis should be cautiously considered,
specifically in a patient with renal impairment and a prolonged treatment period.
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Affiliation(s)
- Tomomi Kajiwara
- Department of General Medicine, Mito Kyodo General Hospital, Japan
| | - Hiroyuki Ariga
- Department of Gastroenterology, Mito Kyodo General Hospital, Japan
| | - Junya Kashimura
- Department of Gastroenterology, Mito Kyodo General Hospital, Japan
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Azarkar G, Birjand MM, Ehsanbakhsh A, Bijari B, Abedini MR, Ziaee M. Ceftriaxone-associated nephrolithiasis and gallstone in adults. DRUG HEALTHCARE AND PATIENT SAFETY 2018; 10:103-108. [PMID: 30588126 PMCID: PMC6296198 DOI: 10.2147/dhps.s183892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Ceftriaxone (CTX) is widely used for the treatment of bacterial infections; however, side effects such as gallstone and nephrolithiasis have been reported in children. There is limited information about urinary tract calculi as CTX side effects in adults. Therefore, the present study was aimed to evaluate the incidence of gallstone and nephrolithiasis following CTX administration. Methods The present study was conducted in the Vali-e-Asr Hospital. Eighty-four patients with various infectious diseases with different daily treatment (mean ± SD: 4.19±2.54) were included in this study, consisting of 49 females and 35 males. The mean of total doses used in patients was 10.2143 (SD: 5.8585). To detect possible gallstone, gallbladder sludge, and urolithiasis, patients were evaluated by serial ultrasound before and after CTX treatment. Patients with renal and hepatobiliary dysfunction were excluded from the study and did not receive any nephrotoxic drugs during this study. Demographic parameters including age, sex, body mass index, dosage of CTX, as well as the duration of treatment and hospitalization were determined. Statistical significances were determined using Fisher’s exact test and independent t-test. Results Results from our study showed that the incidence of gallstone and nephrolithiasis were 8.8% and 1.5% following CTX administration, respectively. Surprisingly, we found a significant correlation in terms of age between patients with and without gallstone (P=0.03). Conclusion Our findings suggest that the patients’ age might play a role in the development of such a complication. This indicates the need for a close monitoring of CTX-treated patients to assess the possible formation of gallstone and nephrolithiasis.
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Affiliation(s)
- Ghodsiyeh Azarkar
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran,
| | - Motahare Mahi Birjand
- Student Research Committee, Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Ehsanbakhsh
- Department of Radiology, Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Bita Bijari
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran,
| | - Mohammad Reza Abedini
- Cellular and Molecular Research Center, Department of Pharmacology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Masood Ziaee
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran,
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Ratti E, Berry JD, Greenblatt DJ, Loci L, Ellrodt AS, Shefner JM, Cudkowicz ME. Preclinical Rodent Toxicity Studies for Long Term Use of Ceftriaxone. Toxicol Rep 2015; 2:1396-1403. [PMID: 26705515 PMCID: PMC4685718 DOI: 10.1016/j.toxrep.2015.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 12/12/2022] Open
Abstract
A 6-month rodent toxicology and pharmacokinetic (PK) study was performed to provide supportive safety data for long-term use of intravenous ceftriaxone in a clinical trial in patients with amyotrophic lateral sclerosis (ALS). Ceftriaxone was administered by subcutaneous injection at up to 2 g/kg/day to Sprague-Dawley Crl:CD (SD) rats. Ceftriaxone was found to be safe and well tolerated. Specifically, no significant differences in body weight and food consumption were observed between the treatment and control groups. With the exception of in red cell parameters decrease, there were no ceftriaxone-related changes in hematology, coagulation, clinical chemistry and urinalysis parameters. Injection site trauma and associated reversible anemia, likely due to chronic blood loss at the injection site, were all attributable to subcutaneous route of administration. Cecum dilatation and some skin changes were reversible after recovery period, while bile duct dilatation, observed only in a few animals, persisted. Changes in the non-glandular stomach do not have a human correlate. The no-observed-adverse-effect dose level (NOAEL) was 0.5 g/kg/day ceftriaxone in both sexes. Ceftriaxone showed rapid absorption with half-life values ranging between 1 and 1.5 hours. Additionally, there was no evidence of accumulation and a virtually complete elimination by 16 hours after the last dose. Overall there were no toxicologically meaningful drug-related animal findings associated with the long-term administration (6 months) of ceftriaxone. These results support safety of long-term use of ceftriaxone in human clinical trials.
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Affiliation(s)
- Elena Ratti
- Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge Street, Suite 600, Boston, MA 02114, USA
| | - James D. Berry
- Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge Street, Suite 600, Boston, MA 02114, USA
| | - David J. Greenblatt
- Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Lorena Loci
- Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge Street, Suite 600, Boston, MA 02114, USA
| | - Amy Swartz Ellrodt
- Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge Street, Suite 600, Boston, MA 02114, USA
| | - Jeremy M. Shefner
- Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Merit E. Cudkowicz
- Neurological Clinical Research Institute (NCRI), Massachusetts General Hospital, 165 Cambridge Street, Suite 600, Boston, MA 02114, USA
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5
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Abstract
PURPOSE OF REVIEW The purpose of this study is to provide an overview of bacterial biliary tract infections in liver transplant recipients with a focus on pathogenesis and conservative treatment strategies. RECENT FINDINGS The development of interventional endoscopic and radiologic interventions has improved the outcome of conservative treatments for bile tract strictures and bilomas. However, recent data show an important rise of infections with multidrug-resistant (MDR) pathogens in liver transplant recipients. SUMMARY Both recurrent cholangitis and infected bilomas are bacterial biliary tract infections in liver transplant recipients responsible for significant morbidity and graft loss, which require a multidisciplinary approach. Risk factors for biliary tract strictures and bilomas formation have recently been identified. With the improved outcome of a conservative management including prolonged and/or recurrent antibiotic treatments, the risk of selecting resistant pathogens is increased. There is an urgent need to develop new strategies to reduce the risk of secondary infections by MDR isolates in liver transplant recipients.
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6
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Increasing urinary calcium excretion after ceftriaxone and cephalothin therapy in adults: possible association with urolithiasis. Urolithiasis 2013; 42:105-8. [DOI: 10.1007/s00240-013-0627-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
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7
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Anuria and abdominal pain induced by ceftriaxone-associated ureterolithiasis in adults. Int Urol Nephrol 2012. [DOI: 10.1007/s11255-012-0330-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Volkova VV, Lanzas C, Lu Z, Gröhn YT. Mathematical model of plasmid-mediated resistance to ceftiofur in commensal enteric Escherichia coli of cattle. PLoS One 2012; 7:e36738. [PMID: 22615803 PMCID: PMC3353932 DOI: 10.1371/journal.pone.0036738] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 04/12/2012] [Indexed: 11/19/2022] Open
Abstract
Antimicrobial use in food animals may contribute to antimicrobial resistance in bacteria of animals and humans. Commensal bacteria of animal intestine may serve as a reservoir of resistance-genes. To understand the dynamics of plasmid-mediated resistance to cephalosporin ceftiofur in enteric commensals of cattle, we developed a deterministic mathematical model of the dynamics of ceftiofur-sensitive and resistant commensal enteric Escherichia coli (E. coli) in the absence of and during parenteral therapy with ceftiofur. The most common treatment scenarios including those using a sustained-release drug formulation were simulated; the model outputs were in agreement with the available experimental data. The model indicated that a low but stable fraction of resistant enteric E. coli could persist in the absence of immediate ceftiofur pressure, being sustained by horizontal and vertical transfers of plasmids carrying resistance-genes, and ingestion of resistant E. coli. During parenteral therapy with ceftiofur, resistant enteric E. coli expanded in absolute number and relative frequency. This expansion was most influenced by parameters of antimicrobial action of ceftiofur against E. coli. After treatment (>5 weeks from start of therapy) the fraction of ceftiofur-resistant cells among enteric E. coli, similar to that in the absence of treatment, was most influenced by the parameters of ecology of enteric E. coli, such as the frequency of transfer of plasmids carrying resistance-genes, the rate of replacement of enteric E. coli by ingested E. coli, and the frequency of ceftiofur resistance in the latter.
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Affiliation(s)
- Victoriya V Volkova
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America.
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Schmutz HR, Detampel P, Bühler T, Büttler A, Gygax B, Huwyler J. In Vitro Assessment of the Formation of Ceftriaxone–Calcium Precipitates in Human Plasma. J Pharm Sci 2011; 100:2300-10. [DOI: 10.1002/jps.22466] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 11/23/2010] [Accepted: 12/07/2010] [Indexed: 11/11/2022]
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10
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Steadman E, Raisch DW, Bennett CL, Esterly JS, Becker T, Postelnick M, McKoy JM, Trifilio S, Yarnold PR, Scheetz MH. Evaluation of a potential clinical interaction between ceftriaxone and calcium. Antimicrob Agents Chemother 2010; 54:1534-40. [PMID: 20086152 PMCID: PMC2849391 DOI: 10.1128/aac.01111-09] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 11/05/2009] [Accepted: 01/11/2010] [Indexed: 11/20/2022] Open
Abstract
In April 2009, the FDA retracted a warning asserting that ceftriaxone and intravenous calcium products should not be coadministered to any patient to prevent precipitation events leading to end-organ damage. Following that announcement, we sought to evaluate if the retraction was justified. A search of the FDA Adverse Event Reporting System was conducted to identify any ceftriaxone-calcium interactions that resulted in serious adverse drug events. Ceftazidime-calcium was used as a comparator agent. One hundred four events with ceftriaxone-calcium and 99 events with ceftazidime-calcium were identified. Adverse drug events were recorded according to the listed description of drug involvement (primary or secondary suspect) and were interpreted as probable, possible, unlikely, or unrelated. For ceftriaxone-calcium-related adverse events, 7.7% and 20.2% of the events were classified as probable and possible for embolism, respectively. Ceftazidime-calcium resulted in fewer probable embolic events (4%) but more possible embolic events (30.3%). Among cases that considered ceftriaxone or ceftazidime and calcium as the primary or secondary drug, one case was classified as a probable embolic event. That patient received ceftriaxone-calcium and died, although an attribution of causality was not possible. Our analysis suggests a lack of support for the occurrence of ceftriaxone-calcium precipitation events in adults. The results of the current analysis reinforce the revised FDA recommendations suggesting that patients >28 days old may receive ceftriaxone and calcium sequentially and provide a transparent and reproducible methodology for such evaluations.
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Affiliation(s)
- Emily Steadman
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dennis W. Raisch
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles L. Bennett
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John S. Esterly
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tischa Becker
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Postelnick
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - June M. McKoy
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Steve Trifilio
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paul R. Yarnold
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marc H. Scheetz
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, VA Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico, University of New Mexico, College of Pharmacy, Albuquerque, New Mexico, VA Chicago Healthcare System and VA Center for Management of Complex Chronic Care, Chicago, Illinois, Divisions of Hematology/Oncology and Geriatric Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Monte SV, Prescott WA, Johnson KK, Kuhman L, Paladino JA. Safety of ceftriaxone sodium at extremes of age. Expert Opin Drug Saf 2008; 7:515-23. [PMID: 18759704 DOI: 10.1517/14740338.7.5.515] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Isolated reports of neonatal and infant deaths associated with ceftriaxone-calcium precipitation in the lungs and kidneys have prompted a recommendation from the US FDA in June 2007 advising that in patients of all ages, calcium-containing solutions should not be administered simultaneously or within 48 h of the last ceftriaxone dose. OBJECTIVE To provide a comprehensive review of the literature surrounding the safety of ceftriaxone in the neonatal (< or = 28 days) and geriatric populations (> or = 65 years). METHODS Multi-database literature search for original research articles, review articles and case reports pertaining to safety of ceftriaxone in the neonatal and geriatric populations. RESULTS/CONCLUSIONS Ceftriaxone should be avoided or significantly minimized in neonates (especially those treated concomitantly with intravenous calcium solutions and those with hyperbilirubinemia), and potentially restricted in the geriatric population treated concomitantly with intravenous calcium.
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Affiliation(s)
- Scott V Monte
- Diabetes and Cardiovascular Research, CPL Associates, LLC, 3980 Sheridan Drive, Amherst, NY 14226, USA.
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12
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Kim S, Gura KM, Puder M. Acute necrotizing cholecystitis: a rare complication of ceftriaxone-associated pseudolithiasis. Pediatr Surg Int 2006; 22:562-4. [PMID: 16485100 DOI: 10.1007/s00383-006-1656-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2006] [Indexed: 10/25/2022]
Affiliation(s)
- Sendia Kim
- Surgery and Vascular Biology, Children's Hospital Boston, Fegan 3, 300 Longwood Avenue, Boston, MA 02115, USA
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13
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Rivkin AM. Hepatocellular enzyme elevations in a patient receiving ceftriaxone. Am J Health Syst Pharm 2005; 62:2006-10. [PMID: 16174837 DOI: 10.2146/ajhp040452] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Anastasia M Rivkin
- Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, 75 DeKalb Avenue, Brooklyn, NY 11201, USA.
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14
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Affiliation(s)
- Daniel Lemberg
- Department of Gastroenterology, Sydney Children's Hospital, Sydney, Australia.
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15
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Avci Z, Koktener A, Uras N, Catal F, Karadag A, Tekin O, Degirmencioglu H, Baskin E. Nephrolithiasis associated with ceftriaxone therapy: a prospective study in 51 children. Arch Dis Child 2004; 89:1069-72. [PMID: 15499067 PMCID: PMC1719698 DOI: 10.1136/adc.2003.044156] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ceftriaxone, a third generation cephalosporin, is widely used for treating infection during childhood. The kidneys eliminate approximately 33-67% of this agent, and the remainder is eliminated via the biliary system. Ceftriaxone may bind with calcium ions and form insoluble precipitate leading to biliary pseudolithiasis. The aim of this study was to assess whether ceftriaxone associated nephrolithiasis develops by the same mechanism, and whether this condition is dose related. METHODS The study involved 51 children with various infections. Of these, 24 were hospitalized with severe infection and received 100 mg/kg/day ceftriaxone divided into two equal intravenous doses. The other 27 patients received a single daily intramuscular injection of 50 mg/kg/day. Serum and urine parameters were evaluated before and after treatment, and abdominal ultrasonographic examinations were also carried out before and after treatment. RESULTS Serum urea, creatinine, and calcium levels were normal in all patients before and after treatment. Post-treatment ultrasound identified nephrolithiasis in four (7.8%) of the 51 subjects. The stones were all of small size (2 mm). Comparison of the groups with and without nephrolithiasis revealed no significant differences with respect to age, sex distribution, duration of treatment, or dose/route of administration of ceftriaxone. The renal stones disappeared spontaneously in three of the four cases, but were still present in one patient 7 months after ceftriaxone treatment. CONCLUSIONS Conclusions: The study showed that children taking a 7 day course of normal or high dose ceftriaxone may develop small sized asymptomatic renal stones. The overall incidence of nephrolithiasis in this study was 7.8%.
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Affiliation(s)
- Z Avci
- Department of Pediatrics, Faculty of Medicine, Bakent University, Ankara, Turkey
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16
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Ito K, Koresawa T, Nakano K, Horie T. Mrp2 is involved in benzylpenicillin-induced choleresis. Am J Physiol Gastrointest Liver Physiol 2004; 287:G42-9. [PMID: 15194559 DOI: 10.1152/ajpgi.00416.2003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Benzylpenicillin (PCG; 180 micromol/kg), a classic beta-lactam antibiotic, was intravenously given to Sprague-Dawley (SD) rats and multidrug resistance-associated protein 2 (Mrp2)-deficient Eisai hyperbilirubinemic rats (EHBR). A percentage of the [(3)H]PCG was excreted into the bile of the rats within 60 min (SD rats: 31.7% and EHBR: 4.3%). Remarkably, a transient increase in the bile flow ( approximately 2-fold) and a slight increase in the total biliary bilirubin excretion were observed in SD rats but not in the EHBR after PCG administration. This suggests that the biliary excretion of PCG and its choleretic effect are Mrp2-dependent. Positive correlations were observed between the biliary excretion rate of PCG and bile flow (r(2) = 0.768) and more remarkably between the biliary excretion rate of GSH and bile flow (r(2) = 0.968). No ATP-dependent uptake of [(3)H]PCG was observed in Mrp2-expressing Sf9 membrane vesicles, whereas other forms of Mrp2-substrate transport were stimulated in the presence of PCG. GSH efflux mediated by human MRP2 expressed in Madin-Darby canine kidney II cells was enhanced in the presence of PCG in a concentration-dependent manner. In conclusion, the choleretic effect of PCG is caused by the stimulation of biliary GSH efflux as well as the concentrative biliary excretion of PCG itself, both of which were Mrp2 dependent.
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Affiliation(s)
- Kousei Ito
- Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 263-8675, Japan
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Bor O, Dinleyici EC, Kebapci M, Aydogdu SD. Ceftriaxone-associated biliary sludge and pseudocholelithiasis during childhood: a prospective study. Pediatr Int 2004; 46:322-4. [PMID: 15151550 DOI: 10.1111/j.1328-0867.2004.01884.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cholelithiasis is a rare condition seen during childhood. The aim of this study was to determine frequency of biliary sludge and cholelithiasis with ceftriaxone therapy. METHODS Thirty-eight children aged between 1 month and 17 years were evaluated with ultrasonographic examination at the initiation of the ceftriaxone therapy and 10th day of therapy, consecutively. If biliary sludge or cholelithiasis were demonstrated, scans were repeated monthly until pathology disappeared. RESULTS Abnormal gallbladder sonograms were demonstrated in 36.8% (n = 14) of patients at the 10th day of therapy. Cholelithiasis was detected in 28.9% (n = 11) of patients and biliary sludge was detected in 7.9% (n = 3). Two children still had cholelithiasis at the 30th day after therapy and one had cholelithiasis after the 60th day. The 9-year-old girl who still had cholelithiasis after 60 days of therapy also had nausea, vomiting and abdominal pain at 7 days after cessation of therapy. Her 90th day sonographic examination was normal. CONCLUSION Reversible biliary sludge or pseudocholelithiasis due to ceftriaxone treatment is not a rare condition. Therefore it is benign, spontaneously resolved and clinical signs are usually absent.
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Affiliation(s)
- Ozcan Bor
- Department of Pediatrics and Radiology, Faculty of Medicine, Osmangazi University, Meselik, Eskisehir, Turkey
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18
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Accatino L, Pizarro M, Solís N, Arrese M, Koenig CS. Bile secretory function after warm hepatic ischemia-reperfusion injury in the rat. Liver Transpl 2003; 9:1199-210. [PMID: 14586882 DOI: 10.1053/jlts.2003.50232] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatic ischemia-reperfusion (I-R) injury frequently is associated with cholestasis. However, the underlying mechanisms are not fully understood. The aim of the study is to assess bile secretory function in vivo in rats subjected to warm lobar hepatic ischemia at different times during reperfusion. A model of lobar 70% warm hepatic ischemia for 30 minutes was used with studies conducted at 1 and 6 hours and 1, 3, and 7 days after reperfusion. Bile secretory function was assessed after selective cannulation of bile ducts of ischemic (ILs) and nonischemic lobes (NILs). Serum activity of hepatic alanine and aspartate aminotransferase was slightly increased in rats subjected to I-R, whereas serum bile salt levels increased early during reperfusion, returning to control values after 7 days. ILs showed mild reversible leukocyte infiltration and no significant necrosis. Bile flow and bile salt excretion were significantly decreased in ILs during the first 24-hour reperfusion period compared with sham-operated rats and NILs. A marked reduction in glutathione (GSH) excretion occurred at 1 and 6 hours and 1 and 3 days, which returned to control values after 7 days. Total GSH and both reduced and oxidized GSH levels in liver homogenate and arterial blood GSH levels were unchanged at all times. Protein mass of multidrug resistance protein 2 and its function, assessed by the hepatic maximum secretory rate of ceftriaxone, did not show significant changes in ILs or NILs compared with sham-operated rats. Liver tissue gamma-glutamyl transpeptidase (GGT) and gamma-glutamylcysteine synthetase activities remained unchanged, whereas biliary GGT and cysteine secretory rates were significantly increased in ILs and NILs. Administration of acivicin, a GGT inhibitor, resulted in decreased secretion of this enzyme into bile and a parallel marked increase in biliary GSH secretion compared with untreated ischemic rats. In conclusion, warm hepatic I-R induces reversible cholestatic changes in ILs. GSH secretory rates from both ILs and NILs were markedly decreased during reperfusion. The reversibility of this effect after GGT inhibition, as well as increased release of active GGT into bile and cysteine biliary secretory rates, suggest increased GSH degradation in bile. These findings might be relevant for the I-R-induced clinical cholestasis, as well as cholangiocyte injury, seen after hepatic ischemia.
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Affiliation(s)
- Luigi Accatino
- Department of Gastroenterology, School of Medicine, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Ko CW, Lee SP. Gastrointestinal disorders of the critically ill. Biliary sludge and cholecystitis. Best Pract Res Clin Gastroenterol 2003; 17:383-96. [PMID: 12763503 DOI: 10.1016/s1521-6918(03)00026-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Biliary sludge develops commonly in critically ill patients and may be associated with biliary colic, acute pancreatitis or acute cholecystitis. Sludge often resolves upon resolution of the underlying pathogenetic factor. It is generally diagnosed on sonography. Treatment of sludge itself is unnecessary unless further complications develop. Acute acalculous cholecystitis also develops frequently in critically ill patients. It may be difficult to diagnose in these patients, manifesting only as unexplained fever, leukocytosis or sepsis. Sonography and hepatobiliary scintigraphy are the most useful diagnostic tests. Management decisions should take into account the underlying co-morbid conditions. For many patients, percutaneous cholecystostomy may be the best management option. Cholecystostomy may also provide definitive drainage as patients recover and underlying critical illness resolves.
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Affiliation(s)
- Cynthia W Ko
- Division of Gastroenterology, Department of Medicine, University of Washington, Box 356424, Seattle, WA 98195, USA.
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20
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Abstract
Biliary sludge is a mixture of particulate solids that have precipitated from bile. Such sediment consists of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts. Sludge is usually detected on transabdominal ultrasonography. Microscopy of aspirated bile and endoscopic ultrasonography are far more sensitive. Biliary sludge is associated with pregnancy; with rapid weight loss, particularly in the obese; with critical illness involving low or absent oral intake and the use of total parenteral nutrition (TPN); and following gastric surgery. It is also associated with biliary stones with common bile duct obstruction; with certain drugs, such as ceftriaxone and octreotide; and with bone marrow or solid organ transplantation. The clinical course of biliary sludge varies. It often vanishes, particularly if the causative event disappears; other cases wax and wane, and some go on to gallstones. Complications caused by biliary sludge include biliary colic, acute cholangitis, and acute pancreatitis. Asymptomatic patients with sludge or microlithiasis require no therapy. When patients are symptomatic or if complications arise, cholecystectomy is indicated. For the elderly or those at risk from the surgery, endoscopic sphincterotomy can prevent recurrent episodes of pancreatitis. Medical therapy is limited, although some approaches may show promise in the future.
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Affiliation(s)
- E A Shaffer
- Faculty of Medicine, Department of Medicine, Foothills Hospital, Room C210, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada.
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21
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Palanduz A, Yalçin I, Tonguç E, Güler N, Oneş U, Salman N, Somer A. Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children. JOURNAL OF CLINICAL ULTRASOUND : JCU 2000; 28:166-168. [PMID: 10751736 DOI: 10.1002/(sici)1097-0096(200005)28:4<166::aid-jcu2>3.0.co;2-g] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Ceftriaxone is a widely used third-generation cephalosporin. In this prospective study, we used sonography to investigate the incidence and outcome of biliary complications in children receiving ceftriaxone therapy. METHODS Ceftriaxone was administered intravenously at a dosage of 100 mg/kg/day for 1-3 weeks to 118 children hospitalized for severe infection. Serial gallbladder sonograms were obtained on days 1, 5-7, and 10-14 of therapy and the day after therapy ended if it had lasted more than 2 weeks. When sonographic abnormalities were found, additional sonograms were obtained every 3 days until the abnormalities had completely resolved. RESULTS Twenty patients (17%), all asymptomatic, demonstrated sonographic abnormalities: 8 had gallbladder sludge, defined as echogenic material without associated acoustic shadowing, and 12 had pseudolithiasis, defined as echogenic material with acoustic shadowing. These abnormalities spontaneously resolved within 2 weeks of stopping the ceftriaxone (mean time to disappearance, 8.2 +/- 3.4 days). No significant differences were found between patients with normal versus abnormal sonographic findings in sex, age, duration of treatment, or other risk factors for drug precipitation. CONCLUSIONS Ceftriaxone-associated biliary pseudolithiasis is usually asymptomatic and was rapidly reversible after cessation of therapy in this group of Turkish children.
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Affiliation(s)
- A Palanduz
- Department of Pediatrics, University of Istanbul, Istanbul Faculty of Medicine, Capa 34390, Istanbul, Turkey
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22
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Bolder U, Trang NV, Hagey LR, Schteingart CD, Ton-Nu HT, Cerrè C, Elferink RP, Hofmann AF. Sulindac is excreted into bile by a canalicular bile salt pump and undergoes a cholehepatic circulation in rats. Gastroenterology 1999; 117:962-71. [PMID: 10500080 DOI: 10.1016/s0016-5085(99)70356-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Dihydroxy bile acids induce a bicarbonate-rich hypercholeresis when secreted into canalicular bile in unconjugated form; the mechanism is cholehepatic shunting. The aim of this study was to identify a xenobiotic that induces hypercholeresis by a similar mechanism. METHODS Five organic acids (sulindac, ibuprofen, ketoprofen, diclofenac, and norfloxacin) were infused into rats with biliary fistulas. Biliary recovery, bile flow, and biliary bicarbonate were analyzed. Sulindac transport was further characterized using Tr(-) rats (deficient in mrp2, a canalicular transporter for organic anions), the isolated perfused rat liver, and hepatocyte membrane fractions. RESULTS In biliary fistula rats, sulindac was recovered in bile in unconjugated form and induced hypercholeresis of canalicular origin. Other compounds underwent glucuronidation and were not hypercholeretic. In the isolated liver, sulindac had delayed biliary recovery and induced prolonged choleresis, consistent with a cholehepatic circulation. Sulindac was secreted normally in Tr(-) rats, indicating that its canalicular transport did not require mrp2. In the perfused liver, sulindac inhibited cholyltaurine uptake, and when coinfused with cholyltaurine, induced acute cholestasis. With both basolateral and canalicular membrane fractions, sulindac inhibited cholyltaurine transport competitively. CONCLUSIONS Sulindac is secreted into bile in unconjugated form by a canalicular bile acid transporter and is absorbed by cholangiocytes, inducing hypercholeresis. At high flux rates, sulindac competitively inhibits canalicular bile salt transport; such inhibition may contribute to the propensity of sulindac to induce cholestasis in patients.
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Affiliation(s)
- U Bolder
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, California, USA
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23
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Affiliation(s)
- M C Maranan
- Department of Pediatrics, The University of Chicago Children's Hospital, IL, USA
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24
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Verkade HJ, de Bruijn MA, Brink MA, Talsma H, Vonk RJ, Kuipers F, Groen AK. Interactions between organic anions, micelles and vesicles in model bile systems. Biochem J 1996; 320 ( Pt 3):917-23. [PMID: 9003381 PMCID: PMC1218016 DOI: 10.1042/bj3200917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Biliary lipid secretion probably involves both 'micellization' and 'vesiculization' of bile-canalicular membrane lipids. Several hydrophilic organic anions inhibit the secretion of lipids into the bile without altering bile salt secretion [Verkade, Vonk and Kuipers (1995) Hepatology 21, 1174-1189]. Hydrophobic organic anions do not interfere with biliary lipid secretion. We investigated whether the organic-anion-induced inhibition of biliary lipid secretion in vivo could be attributed to inhibition of micellization, by the application of in vitro models of micellization. Carboxyfluorescein was entrapped in a self-quenching concentration in small unilamellar vesicles (SUV) composed of cholesterol/egg phosphatidylcholine (molar ratios 0, 0.2 and 0.5). Certain organic anions clearly affected the bile-salt-induced release of fluorescence from these SUV, reflecting interference with micellization. However, the effects of hydrophilic and hydrophobic organic anions did not correspond with their effects on biliary lipid secretion in vivo, irrespective of the bile salt species used (taurocholate, taurodeoxycholate or tauroursodeoxycholate) and of the lipid composition of the SUV. Ultracentrifugation and dynamic light-scattering studies indicated that organic anions do interact with bile salt/ phosphatidylcholine/cholesterol mixed micelles, but that they do not inhibit micellization, for example by competing with phosphatidylcholine and/or cholesterol for incorporation into mixed micelles. In conclusion, the present in vitro data indicate that the in vivo mechanism of organic-anion-induced inhibition of biliary lipid secretion is not mediated by inhibition of micellization.
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Affiliation(s)
- H J Verkade
- Groningen Institute for Drug Studies, Department of Pediatrics, University Hospital Groningen, The Netherlands
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25
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Takikawa H, Nishikawa K, Sano N, Yamanaka M, Horie T. Mechanisms of biliary excretion of lithocholate-3-sulfate in Eisai hyperbilirubinemic rats (EHBR). Dig Dis Sci 1995; 40:1792-7. [PMID: 7648982 DOI: 10.1007/bf02212704] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Biliary excretion of lithocholate-3-sulfate is markedly impaired in EHBR. To examine the mechanism of biliary lithocholate-3-sulfate excretion in EHBR, the effects of colchicine treatment, a vesicular transport inhibitor, and infusion of taurocholate and organic anions were studied in EHBR and Sprague-Dawley rats. Colchicine treatment and taurocholate infusion had no effect of biliary lithocholate-3-sulfate excretion in EHBR, suggesting that biliary lithocholate-3-sulfate excretion is not mediated by the vesicular transport or by the bile acid excretory pathway. In control Sprague-Dawley rats, both sulfobromophthalein and dibromosulfophthalein infusion inhibited biliary lithocholate-3-sulfate excretion. In contrast, in EHBR dibromosulfophthalein infusion inhibited biliary lithocholate-3-sulfate excretion but BSP infusion did not. Indocyanine green and pravastatin infusion did not affect biliary lithocholate-3-sulfate excretion but pravastatin infusion had no effect in EHBR. These findings indicate that, whether physiologically important or not, two of more excretory pathways for organic anions exist at the canalicular membrane other than the ATP-dependent one.
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Affiliation(s)
- H Takikawa
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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26
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Renal and nonrenal clearances of ceftriaxone at the steady-state and its relation to plasma protein binding. Eur J Pharm Sci 1995. [DOI: 10.1016/0928-0987(95)00003-v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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28
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Oude Elferink RP, Jansen PL. The role of the canalicular multispecific organic anion transporter in the disposal of endo- and xenobiotics. Pharmacol Ther 1994; 64:77-97. [PMID: 7846117 DOI: 10.1016/0163-7258(94)90034-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Bile is an important excretory route for the elimination of amphiphilic organic anions, and hepatocytes are the primary secretory units of bile formation. The hepatocytic basolateral and canalicular membranes are equipped with various carrier proteins. Transport across the canalicular membrane represents a major concentrative step. Various ATP-dependent transporters have been identified, such as a multispecific organic anion transporter (canalicular multispecific organic ion transporter, cMOAT), a bile acid transporter and several P-glycoproteins. TR- rats, which lack cMOAT activity, have been valuable in defining the substrate specificity of cMOAT. A wide range of glucuronide-, glutathione- and sulfate-conjugates are transported by this system.
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Affiliation(s)
- R P Oude Elferink
- Department of Gastrointestinal Disease, Academic Medical Center, Amsterdam, The Netherlands
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29
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Lebovics E, Halata MS, Rosario JA, Lantin J, Schwarz SM, Rosenthal WS. Endoscopic management of ceftriaxone pseudolithiasis involving the common bile duct and gallbladder. Gastrointest Endosc 1994; 40:246-8. [PMID: 8013837 DOI: 10.1016/s0016-5107(94)70182-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- E Lebovics
- Department of Medicine, New York Medical College, Valhalla 10595
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30
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Stein A, Antoni M, Christophe M, Raoult D. Pseudo-lithiase biliaire médicamenteuse et ceftriaxone : deux observations. Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)80968-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Abstract
Ceftriaxone-associated sludge has been a fascinating story. The occurrence is novel and unique. It has produced a model of gall-bladder sludge in humans. This phenomenon has taught us a great deal about biliary lipid and organic anion excretion by the liver, and the physical chemistry of calcium and calcium sensitive anions. It has added further insights into the pathophysiology of gall-bladder sludge formation. It points to a combination of a hepatic effect where the liver secretes a biochemically abnormal bile, and a gall-bladder effect which provides an environment for precipitation, in order for sludge to develop. The precipitated calcium ceftriaxone has prompted us to re-evaluate the imaging criteria for the diagnosis of gall-bladder sludge versus gallstones. Above all, the rapid onset and rapid disappearance of ceftriaxone sludge has mirrored in a compressed, encapsulated form, the natural history of gall-bladder sludge. It has reminded us that, like gallstones, biliary sludge is usually benign and asymptomatic. However just because it is smaller than gallstones does not mean it cannot cause problems. It can disappear or it can become a calcium ceftriaxone gallstone.
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Affiliation(s)
- Y S Kim
- Department of Medicine, University of Washington, Seattle
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32
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Affiliation(s)
- R Coleman
- School of Biochemistry, University of Birmingham, UK
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33
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Michielsen PP, Fierens H, Van Maercke YM. Drug-induced gallbladder disease. Incidence, aetiology and management. Drug Saf 1992; 7:32-45. [PMID: 1536697 DOI: 10.2165/00002018-199207010-00005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A great variety of drugs is reported to induce gallbladder disease by various pathogenetic mechanisms. Early epidemiological studies indicated a doubled risk of gallbladder disease in women taking oral contraceptives. More recent studies, however, have failed to confirm those findings; these conflicting results might be explained by the different methods used to define gallbladder disease. It was shown that the lithogenic index of the bile is increased during intake of oral contraceptives. Estrogens cause hypersecretion of cholesterol in bile, due to increase in lipoprotein uptake by the hepatocyte. Progesterone inhibits acyl coenzyme A-cholesterol acyl transferase (ACAT) activity, causing delayed conversion of cholesterol to cholesterol esters. Of the lipid lowering drugs, only clofibrate has been shown to increase the risk for gallstone formation. The other fibric acid derivatives have similar properties, but clinical experience is not as extensive. They seem to be inhibitors of the ACAT enzyme system, thereby rendering bile more lithogenic. Conflicting epidemiological data exist regarding the induction of acute cholecystitis by thiazide diuretics. Ceftriaxone, a third-generation cephalosporin, is reported to induce biliary sludge in 25 to 45% of patients, an effect which is reversible after discontinuing the drug. The sludge is occasionally a clinical problem. It was clearly demonstrated that this sludge is caused by precipitation of the calcium salt of ceftriaxone excreted in the bile. Long term use of octreotide is complicated by gallstone formation in approximately 50% of patients after 1 year of therapy, due to gallbladder stasis. Hepatic artery infusion chemotherapy by implanted pump is shown to be associated with a very high risk of chemically induced cholecystitis. Prophylactic cholecystectomy at the time of pump implantation is therefore advocated. Some drugs, such as erythromcyin or ampicillin, are reported to cause hypersensitivity-induced cholecystitis. Furthermore, there are reports on the influence of cyclosporin, dapsone, anticoagulant treatment, and narcotic and anticholinergic medication in causing gallbladder disease.
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Affiliation(s)
- P P Michielsen
- Division of Gastroenterology, University Hospital of Antwerp, Edegem, Belgium
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34
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35
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Jacobs RF. Efficacy and safety of cefotaxime in the management of pediatric infections. Infection 1991; 19 Suppl 6:S330-6. [PMID: 1791079 DOI: 10.1007/bf01715774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The utilization of cephalosporins in serious bacterial infections in children has become more widely accepted by pediatric infectious disease specialists over the past five years. The use of cephalosporins has become increasingly popular in empiric antibiotic regimens. The recognition that age-specific bacterial pathogens in neonates, older infants and children can be effectively treated with cephalosporins alone, or in combination with ampicillin, has led to this increasing popularity. This review will discuss the use of cephalosporins in empiric antibiotic regimens and relate the efficacy and safety of specific cephalosporins in the treatment of serious bacterial infections in children.
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Affiliation(s)
- R F Jacobs
- University of Arkansas for Medical Sciences, Little Rock
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36
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Park HZ, Lee SP, Schy AL. Ceftriaxone-associated gallbladder sludge. Identification of calcium-ceftriaxone salt as a major component of gallbladder precipitate. Gastroenterology 1991; 100:1665-70. [PMID: 2019372 DOI: 10.1016/0016-5085(91)90667-a] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ceftriaxone, a third-generation cephalosporin, is partially excreted into bile. With its clinical use, the formation of gallbladder sludge detected by ultrasonography has been reported. Four surgical specimens were examined and no gallstones were found. Instead, fine precipitates of 20-250 microns were present. Microscopically, there was a small number of cholesterol monohydrate crystals and bilirubin granules among an abundant amount of granular-crystalline material that was not morphologically cholesterol monohydrate crystals. The chemical composition of the precipitates (n = 4) was determined. There was a small amount of cholesterol (1.7% +/- 0.8%) and bilirubin (13.9% +/- 0.74%). The major component of the precipitate was a residue. On further analysis using thin-layer chromatography, high-performance liquid chromatography, and electron microprobe analysis, the residue was identified as a calcium salt of ceftriaxone. The residue also had identical crystal morphology and chromatographic elution profile as authentic calcium-ceftriaxone standards. It is concluded that ceftriaxone, after excretion and being concentrated in the gallbladder bile, can form a precipitate. The major constituent has been identified as a ceftriaxone-calcium salt.
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Affiliation(s)
- H Z Park
- Department of Medicine, University of Washington School of Medicine, Seattle
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37
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Cava F, Gonzalez J, Gonzalez-Buitrago JM, Muriel C, Jimenez R. Inhibition of biliary cholesterol and phospholipid secretion by cefmetazole. The role of vesicular transport and of canalicular events. Biochem J 1991; 275 ( Pt 3):591-5. [PMID: 1674860 PMCID: PMC1150095 DOI: 10.1042/bj2750591] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A number of organic anions selectively inhibit the biliary secretion of cholesterol and phospholipids without affecting bile acid secretion. We studied the effect of cefmetazole, a third-generation cephalosporin, on biliary lipid secretion in the rat. Injection of cefmetazole at a dose of 200 mumol/kg body wt. induced a choleretic effect and a significant decrease in the biliary output of cholesterol and phospholipid, without changes in bile acid secretion. The decrease was more marked for cholesterol than for phospholipid secretion, with a significant decrease in their molar ratio in bile. The effects were apparently unrelated to an inhibition of intracellular vesicular transport because, after injection of horseradish peroxidase, both the time course and total amount secreted of the protein did not significantly differ between control animals and those receiving cefmetazole. The secretory rate of the lysosomal marker acid phosphatase was not affected by cefmetazole administration. Biliary outputs of the plasma-membrane enzymes alkaline phosphatase and gamma-glutamyltransferase were significantly decreased by the antibiotic. These results point to an effect of cefmetazole at the level of the canalicular membrane.
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Affiliation(s)
- F Cava
- General Hospital of Salamanca, Spain
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38
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Shiffman ML, Keith FB, Moore EW. Pathogenesis of ceftriaxone-associated biliary sludge. In vitro studies of calcium-ceftriaxone binding and solubility. Gastroenterology 1990; 99:1772-8. [PMID: 2227290 DOI: 10.1016/0016-5085(90)90486-k] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ceftriaxone, a semisynthetic third-generation cephalosporin, has recently been associated with biliary sludge formation. Analysis of the biliary concretions induced by this agent shows a calcium salt of ceftriaxone. The present in vitro studies were undertaken to provide insight into the pathogenesis of ceftriaxone-associated biliary sludge formation by evaluating possible interactions that may exist between calcium, bile salts, and ceftriaxone. Ceftriaxone possessed high calcium-binding affinity. The formation constant for the calcium ceftriaxone salt at 37 degrees C was about 157.3 L/mol; stoichiometry of the salt was 1:1, i.e., calcium ceftriaxone. The calcium-binding property of ceftriaxone was observed to be additive to that of taurocholate in mixed taurocholate-ceftriaxone solutions. Although the solubility product constant for calcium ceftriaxone was only 1.62 x 10(-6) mol/L2, marked metastability was observed; neither visible nor microscopic precipitates developed until the [Ca2+] x [ceftriaxone] ion product exceeded the solubility product constant by a factor of 10.4. Metastability of the calcium ceftriaxone salt was also observed in human gallbladder bile in vitro. Estimates of human biliary calcium ceftriaxone solubility in vivo were than calculated from previously-reported values for biliary [Ca2+], [ceftriaxone], and from the solubility product constant as defined in this study. Calculated saturation indices for calcium-ceftriaxone in human bile generally increased (corresponding to a decrease in solubility) with increasing ceftriaxone dose. At doses less than or equal to 1 g, saturation index was well within the metastable range of this calcium-salt. However, at doses greater than or equal to 2 g, the saturation index surpassed the metastable limit. Under these conditions, precipitation of ceftriaxone could occur. It was concluded that the development of ceftriaxone-induced biliary sludge is a solubility problem that occurs in patients receiving high-dose treatment (greater than or equal to 2 g). This study proposes that the risk of developing ceftriaxone-associated biliary "pseudolithiasis" increases with increasing ceftriaxone dose and in patients with impaired gallbladder emptying.
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Affiliation(s)
- M L Shiffman
- Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond
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