Ceftriaxone is an antibacterial drug widely used to treat various infectious diseases in pediatrics. It has been previously found that the use of ceftriaxone can cause unwanted drug reactions such as pseudo-cholelithiasis and kidney stone formation, as well as softness (thick suspension) in the bladder. The formation of urinary crystals that adhere to renal tubule cells during treatment with ceftriaxone is described, which may be a potential cause of acute renal failure. Several studies have described cases of the development of acute kidney failure in children caused by ceftriaxone, but, fortunately, the frequency of such a serious complication is extremely low. The frequency of occurrence of kidney stones during treatment with ceftriaxone is approximately 1%, while in most patients this complication of pharmacotherapy is asymptomatic, diagnosed by chance during an ultrasound and stopped spontaneously.

According to a study published in the March issue of the journal Pediatrics, the use of therapeutic doses of ceftriaxone can lead to kidney stones and the development of acute renal failure in children, which is completely reversible with early treatment.

The aim of the study in China was to assess the clinical profile, treatment and outcomes of acute renal failure occurring in children with ceftriaxone.

In retrospect, from 2003 to 2012, 31 cases of development of acute renal failure during treatment with ceftriaxone were analyzed. In the history of patients, there was no indication of urolithiasis or any other pathology of the kidneys.

The average age of the children was around 5 years. Ceftriaxone has been prescribed at a dose of 70 to 100 mg / kg / day (on average, 86.7 mg / kg / day). The average duration of ceftriaxone before the development of acute renal failure was 5.2 days. The main symptoms of the disease were (with the exception of acute anuria, observed in 100% of patients), pain in the projection area of the kidneys (in patients older than 3 years, 25/25 patients ), severe crying (in children under 3 years old, 6/6 patients) and vomiting (19/31 children). Ultrasound revealed minor hydronephrosis (25/31 patients) and kidney stones (11/31 patients). In 9 children, recovery was observed 1 to 4 days after the start of pharmacological treatment (antispasmodic treatment with anisodamine, alkalization with sodium bicarbonate, prescription of antibiotics, proteins and low doses of dexamethasone).

In 21 children whose conventional pharmacotherapy was ineffective, retrograde urethral catheterization was performed. After catheterization, urine was collected and symptoms stopped immediately. Catheterization was ineffective in 1 child, who then had 3 hemodialysis sessions, after which normal urination was restored. The average duration of treatment was 1.8 days, the average duration of the period of anuria was 3.1 days.

During mass spectrometry analysis, ceftriaxone was found to be the main component of stones in 4 children. Recovery occurred in all of the patients observed.

Thus, antibiotic therapy using ceftriaxone can cause the development of acute renal failure. Earlier diagnosis and prompt pharmacologic intervention are the most important factors for the rapid relief of this condition. Retrograde urethral catheterization is an effective treatment in children who have not responded to pharmacotherapy.

Based on the data obtained, the authors recommend that in the event of sudden anuria or low back pain in children receiving ceftriaxone, the antibiotic should be withdrawn immediately to confirm the diagnosis, an ultrasound and treatment should be prescribed as soon as possible, because the acute renal failure caused by the introduction of ceftriaxone is reversible and characterized with adequate and rapid treatment, a good prognosis.

This study was conducted in China and the question of how its results can be transferred to other countries remains open. This is mainly due to the fact that the drugs used are not registered in other countries, including the United States, or that their use is not regulated by the directives. In the study, Chinese herbal preparation was used as an antispasmodic. This fact may have led to the need for fairly frequent catheterization without extracorporeal shock wave lithotripsy.

Due to the limited knowledge regarding this complication, no preventive measures can be recommended. Theoretically, dehydration should be avoided and adequate rehydration (usually intravenous) should be provided to stop the restoration of normal urination. The only reasonable advice is to avoid an extra calcium prescription and a low sodium diet while taking ceftriaxone. It may be appropriate to use thiazide diuretics. In any case, more research is needed to study the preventive measures regarding stone formation when using ceftriaxone.