Reuters Health Information (2014-04-01): Acute renal failure a possible complication of ceftriaxone use in children


Acute renal failure a possible complication of ceftriaxone use in children

Last Updated: 2014-04-01 11:00:51 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The cephalosporin antibiotic ceftriaxone may cause acute renal failure in children in rare cases, according to a Chinese study.

"The incidence of ceftriaxone-associated postrenal acute renal failure is very low," senior author Dr. Wen Zhang, of Tongji Hospital in Wuhan, told Reuters Health by email. "However, we believe the doctor should keep in mind the particular complication and once encountered, adopt proper treatment before irreversible lesions occur."

Dr. Zhang said Tongji Hospital is one of the largest in China, however only 31 children with postrenal acute renal failure related to ceftriaxone were admitted between January 1, 2003 and June 30, 2012.

Dr. Gaurav Kapur, the director of pediatric dialysis at Children's Hospital of Michigan and an assistant professor of pediatrics at Wayne State University in Detroit, said the finding was noteworthy because ceftriaxone is so commonly used.

"Awareness of a complication related to a very commonly used medication is important," Dr. Kapur told Reuters Health. Speaking of this and other rare complications associated with ceftriaxone use in children, he said, "I'm just a little bit more aware when I'm using ceftriaxone, but it's not changed my practice."

Dr. Kapur was not involved in the new study.

Among the 31 cases seen at Tongji Hospital, the average time from ceftriaxone administration to acute renal failure was 5.2 days, the authors report in Pediatrics, online March 24.

Main symptoms were sudden anuria, flank pain, excessive crying, and nausea or vomiting.

In all cases, the effects were reversible. Nine patients responded to drug therapies, which included anisodamine, albumin and low-dose dexamethasone, sodium bicarbonate, and antibiotics.

Twenty-one children who did not respond to medical treatments underwent retrograde ureteral catheterization. One child failed catheterization and required hemodialysis.

The investigators, led by Dr. Ning Li, believe ceftriaxone crystallizes with calcium in the urine and forms stones that obstruct the ureters, which leads to acute renal failure.

"According to our experience, it is a particular problem in children," Dr. Zhang said. "We presume that the ceftriaxone crystal is not as solid as other renal stones, and children have smaller ureters and slower urine flow, so the blockage is more likely to form in children. In adults, the crystal may be flushed away by urine."


Pediatrics 2014.