Ceftriaxone-Induced Biliary and Renal Complications
Summary
Ceftriaxone is a third-generation cephalosporin widely employed in the treatment of serious bacterial infections. Its high biliary excretion and calcium-binding properties predispose to precipitation within the gallbladder, leading to biliary sludge, pseudolithiasis and, in rare instances, true lithiasis or acute cholecystitis. Renal complications arise through similar mechanisms, with ceftriaxone–calcium complexes crystallising in the urinary tract and forming nephrolithiasis or ureteric obstruction. While most biliary and urinary deposits are reversible upon drug discontinuation, prolonged or high-dose regimens—particularly in vulnerable populations such as children, elderly patients or those with renal impairment—may precipitate symptomatic obstruction, cholestasis, inflammatory sequelae or require surgical or endoscopic intervention. Recognition of risk factors, timely imaging and appropriate management strategies are essential to mitigate morbidity and preserve organ function.
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Ceftriaxone-Induced Biliary and Renal Complications publication trend
The graph below shows the total number of articles in ceftriaxone-induced biliary and renal complications across all publications each year (not limited to Nature Index journals).
Technical terms
Pseudolithiasis: Transient formation of sludge or calculi composed of ceftriaxone–calcium complexes in the biliary tract.
Acute cholecystitis: Sudden inflammation of the gallbladder, often causing pain, fever and possible infection.
Nephrolithiasis: Formation of crystalline stones within the kidney or urinary tract, potentially causing obstruction.
Cholestasis: Impairment of bile flow leading to accumulation of bile acids and bilirubin in the liver and bloodstream.
References
- A case report and literature review: one case of ceftriaxone sodium-induced reversible gallbladder stone. Frontiers in Medicine (2024).
- Ceftriaxone-associated pseudolithiasis in hemodialysis patients: a case series study. Renal Replacement Therapy (2021).
- Clinical features and outcomes of pseudolithiasis induced by ceftriaxone in Chinese children: a single-center observational study. Frontiers in Pediatrics (2025).
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