• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.1 no.1
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• pp.100-106
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• 1998

Purpose: Ceftriaxone, a potent parenteral third-generation semisynthetic cephalosporin is widely used for the treatment of a variety of bacterial infections in both children and adult. Review of recent data indicates that ceftriaxone treatment has been associated with the development of reversible biliary pseudolithiasis and that is thought by many to be a benign process. Despite, several reports describe patients with ceftriaxone pseudolithiasis who required cholecystectomy for presumed acute cholecystitis. In this study we evaluated the incidence, risk factors, and prognosis of gallbladder pseudolithiasis after ceftriaxone treatment. Methods: Between march, 1997 and January, 1998, any child admitted to the Children's hospital of National University of Seoul and prescribed ceftriaxone for probable or definite bacterial infection were eligible for the study. 21 of them had ultrasound examination on the 2~12 days later after the start of ceftriaxone treatment, 8 of whom documented gallbladder precipitates or pseudolithiasis during treatment by serial abdominal ultrasound. Repeat abdominal ultrasound was performed 10~80 days later after the end of ceftriaxone treatment. The children with underlying liver disease or decreased renal function were excluded in this study. Results: 1) 21 children had ultrasound examinations of gallbladder during ceftriaxone treatment and 8 (38%) of them acquired pseudolithiasis. 2) The patients who developed gallbladder pseudolithiasis were significantly older ($6.3{\pm}2.9$ yr. vs $2.2{\pm}3.1$ yr.)(p<0.05), and older than 24 months were probably the significant risk associated with this phenomenon (p<0.05). However, no significant differences in sex, type of infection, fasting, and ceftriaxone treatment regimen (dose, duration of therapy). 3) The abnormality found on gallbladder ultrasonography was a strikingly hyperechogenic material with post-acoustic shadowing in 5 patients without post-acoustic shadowing in 3 patients 4) Follow up of gallbladder ultrasound was performed in 6 patients after cessation of ceftriaxone treatment. Sonographic abnormalities completely resolved within 14 days post cessation of therapy in 2 patients; 30 days, 1 patient; 80 days, 3 patients. Conclusions: We suggest that routine abdominal ultrasound should be considered in all children who received high dose ceftriaxone in more than 24 months of age and developed hepatobiliary symptoms during or just after ceftriaxone treatment.

• Pediatric Infection and Vaccine
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• v.4 no.2
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• pp.308-313
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• 1997

Ceftriaxone, an effective third generation cephalosporin with a wide range of antimicrobial activity, has become widely used by pediatricians for a variety of bacterial infections including meningitis. It has been associated with the development of sludge or stone in the gallbladder of some patients treated with this drug. Ceftriaxone associated biliary sludge has unusual acoustic characteristics and resembles gallstone. The sludge can cause symptoms such as cramping abdominal pain, and disappears after stopping ceftriaxone administration. Because of these seemingly confusing observations, it is important for the clinicians to recognize these findings that ceftriaxone treatment can cause. We report a case of ceftriaxone associated biliary sludge in Korean children. A 6-year-old girl who was treated for meningitis with ceftriaxone (100mg/kg/day) developed cramping upper abdominal pain from 5th hospital day. Physical examination, liver function tests and X-ray revealed no specific abnormal findings. But abdominal ultrasound revealed high amplitude echogenic sludge with prominent post-acoustic shadow in gallbladder and its diameter was 1.5cm. We stopped ceftriaxone administration and tried conservative care. Abdominal cramping pain subsided after 3 days of ceftriaxone removal. Second abdominal ultrasound confirmed the disappearance of sludge at 3 weeks later.

• Advances in pediatric surgery
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• v.20 no.2
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• pp.62-64
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• 2014

Gallbladder stones in children are not common without underlying hemolytic diseases or other risk factors like obesity. Ceftriaxone, a third generation cephalosporin, is known to make biliary precipitations that can be mistaken for biliary stones. We here report two children with biliary pseudolithiasis with different treatment modalities. One child was mistaken for symptomatic gallbladder stones and underwent elective laparoscopic cholecystectomy, while the other child, after thorough history taking on the ceftriaxone medication, was suspected of biliary pseudolithiasis and was treated conservatively. Both children had the history of usage of ceftriaxone in previous hospitals for infectious diseases. The ceftriaxone history of the first child was missed before the surgery. When gallbladder stones are found in children without any underlying diseases, specific history taking of the usage of ceftriaxone seems to be absolutely required. In this case, immediate interruption of the antibiotic could resolve the episode and avoid unnecessary surgical procedure.

• Korean Journal of Clinical Pharmacy
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• v.8 no.1
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• pp.54-58
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• 1998

The stability of ceftriaxone sodium 100 mg/ml in the water for injection was tested at two temperature conditions (refrigerator and room temperature) and two storage containers (vitro and syringe). The stability of each sample was determined by high-performance liquid chromatography while storing for 5 days at room temperature and 27 days at refrigerator. The concentration of ceftriaxone sodium was 100 mg/ml which the hospital usually use as a filling preparation for I.V. push or Y-site injection. There was no significant difference between the storage in vials and syringes. There was no significant difference in the change of concentration until storing the reconstituted ceftriaxone sodium injection for 2 days at room temperature and 14 days at refrigerator. In conclusion, the ceftriaxone sodium 100 mg/ml in the water for injection can be stored in vial or syringe for 2 days at room temperature and 14 days at refrigerator after preparation.

• Korean Journal of Clinical Pharmacy
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• v.14 no.2
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• pp.96-99
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• 2004

Aminophylline, ceftriaxone 및 ampicillin/sulbactam (Unasyn)을 미숙아용 고영양수액제에 직접 첨가하거나 Y-site로 투여하는 경우의 안정성에 관해 조사하였다. Aminophylline 주사액 (25mg/mL) $300{\mu}l$와 ceftriaxone sodium (37.5 mg/mL) 2mL를 각각 고영양수액제 직접 첨가하였다. 또한 Y-site에서의 안정성 조사를 위해 ceftriaxone sodium (37.5 mg/mL)을 고영양수액제에 각각 1:1 및 1:2 부피비가 되도록 혼합하였고 Unasyn (25mg/mL)은 고영양수액제와 1:1의 부피비로 혼합하였다. 이상과 같이 조제한 혼합액을 $25^{\circ}C$와 $4^{\circ}C$에 보관하여 aminophylline은 48시간 동안 그리고 항생제들은 24시간 동안의 경시변화를 HPLC를 이용하여 분석하였다. Aminophylline은 위 보존조건에서 48시간동안 안정하였다(변화율 <$10{\%}$). Ceftriaxone sodium을 고영양수액제에 직접 첨가한 경우 ceftriaxone의 잔존률은 $25^{\circ}C$에서 4시간째에 $90.5{\pm}1.8{\%}$이었고 $4^{\circ}C$에는 $95.1{\pm}1.4{\%}$로 측정되었다. Y-site에서의 안정성과 관련하여 ceftriaxone sodium을 고영양수액제와 1:1로 혼합한 경우 양 보존조건에서 ceftriaxone은 24시간 동안 안정하였으나 1:2로 혼합한 경우에는 $4^{\circ}C$ 보관 시에만 안정하였고 $25^{\circ}C$에서는 24시간째에 약 $14{\%}$ 정도 분해되는 것으로 나타났다. 한편, Unasyn의 경우 ampicillin은 24시간째에 $4^{\circ}C$ 보관 시에만 안정하였고 $25^{\circ}C$에서는 24시간째에 약 $14{\%}$정도 분해되는 것으로 나타났다. 한편, Unasyn의 경우 ampicillin은 24시간째에 $4^{\circ}C$에서는 안정하였으나 $25^{\circ}C$에서는 $30{\%}$까지 감소되는 것으로 분석되었고 sulbactam은 24시간째에 온도와 관계없이 안정한 것으로 나타났다. Ceftriaxone sodium을 TPN과 Y-site 혼합 후 1-2시간 이내에 침천이 형성되었고 Unasyn의 경우에는 12시간째에 침천이 형성되었다. 혼합액의 pH나 색상은 연구기간 동안 일정하였다. 이러한 연구결과에 기초할 때, aminophylline은 고영양수액제와 혼합가능하고 ceftriaxone과 Unasyn은 고양양수액제와 혼합시 최소 1시간 동안은 안정한 것으로 평가되었다.

• Journal of Life Science
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• v.17 no.10
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• pp.1426-1433
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• 2007

To investigate the antibiotic resistant patterns of the bacteria producing ESBL, we isolated one organism of Klebsiella pneumoniae from a clinical laboratory in Busan. The organism that produces ESBL gene was detected by double disk synergy test and the presence of three ESBL genes (TEM-1, SHV-12, CTX-M-15) was confirmed by polymerase chain reaction and DNA sequencing analysis. To analyse the characteristics of three ESBL genes, we performed transconjugation, transformation and cloning experiment with the organism. The MIC of Klebsiella pneumoniae was revealed that ceftazidime, cefotaxime and ceftriaxone were $256\;{\mu}g/ml,\;128\;{\mu}g/ml\;and\;128\;{\mu}g/ml$ respectively. The MIC of conjugant (E. coli $RG176^{Na(r)}$) af was revealed that ceftazidime, cefotaxime and ceftriaxone were $256\;{\mu}g/ml,\;64\;{\mu}g/ml\;and\;128\;{\mu}g/ml$ respectively. The MIC of transformant (E. cofi $DH5{\alpha}$) was revealed that ceftazidime, cefotaxime and ceftriaxone were $128\;{\mu}g/ml,\;32\;{\mu}g/ml,\;and\;32\;{\mu}g/ml$ respectively, The MIC of cloned organism of SHV-12 gene (E. coli $DH5{\alpha}$) was revealed that ceftazidime, cefotaxime and ceftriaxone were $128\;{\mu}g/ml,\;8\;{\mu}g/ml,\;and\;32\;{\mu}g/ml$ respectively. The results indicated that MIC of conjugant was higher than MIC of transformant and also SHV-12 gene were not resistant against cefotaxime antibiotic.

• Korean Journal of Veterinary Research
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• v.54 no.1
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• pp.27-30
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• 2014

The jejunum is the longest part of the small intestine and its lumen is mainly involved in the absorption of the nutrients. The present study was conducted to evaluate the effects of metronidazole, ceftriaxoine sodium and their combination on the stenotic index of the end to end jujunal anastomotic site. To accomplish this, 20 healthy stray dogs were subjected to end to end jejunal ansastmosis. Dogs in Group A (control) underwent jejunal anstomosis with no antibiotic prophylaxis, while those in Group B received surgery and metronidazole alone at 50 mg/kg, those in Group C received ceftriaxone sodium intravenously at 30 mg/kg body weight prior to surgery and dogs in Group D were given metronidazole in combination with ceftriaxone sodium at 50 mg/kg and 30 mg/kg, respectively, 2 h before surgical intervention. No significant difference (p > 0.05) in the stenotic index was observed at 14 days after jejunal anastomosis. These findings indicate that prophylactic administration of metronidazole and ceftriaxone sodium alone or in combination had no significant effect on the stenotic index of the jejunum.

• YAKHAK HOEJI
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• v.50 no.1
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• pp.40-46
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• 2006

Square wave voltammetric (SWV) and cyclic voltammetric (CV) behaviors of cefotaxime sodium and ceftriaxone sodium have been investigated in the potential range between -0.10 V and -1.30 V using the phosphate buffers of various pH values ($2.00{\sim}9.10$). Two main peaks observed were irreversible and protons were involved in their electrochemical reductions. The first peaks of these cephalosporin antibiotics are due to the reduction of the azomethine double bond in the methoxyimino group of the side chain at position 7. The second peaks of cefotaxime sodium and ceftriaxone sodium are related to the reductions of the ${\Delta}^3$ double bond and the dioxo moiety of the side chain at position 3, respectively. The calibration curve of cefotaxime sodium in the concentration range between $1.0{\times}10^{-7}M$ and $1.0{\times}10^{-5}M$ yielded the linearity with the correlation coefficient of 0.9998 when the first peak of the antibiotic in a phosphate buffer of pH 3.02 was measured at the conditions of frequency of 120 Hz and pulse height of 50 mV by SWV. The present fast, simple and accurate SWV assay method was applied to determine cefotaxime sodium in the commercial antibiotic powder of injection.

• Archives of Pharmacal Research
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• v.18 no.4
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• pp.237-242
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• 1995

For the vioequivalence study of two ceftriaxone injection formulations ($Rocephin{\circledR}$ ; Roche, and Triaxone ; Hanmi0, the HPLC analytical method for the analysis of ceftriaxone in plasma was used. Fourteen healthy volunteers completed the study and each subject were IM in jected signle doses (1 g) of the test and the reference formulations in a two-way crossover design with an one week drug free interval between doses. Following each administration, plasma concentrations of ceftrixone were monitored over a period of 24 h. Bioequivalence parameters $AUC_{24th}, {\;}T_{max}, {\;}C_{max}$ and MRT determined from the data obtained for the two formulations were examined by analyses of variance (ANOVA) and other criteria and tests for bioequivalence. Results of ANOVA and confidence limits of test/reference ratios of $AUC_{24th}, {\;}T_{max}, {\;}C_{max}$ and MRT, and statistical tests indicated the bioequivalence of the two formulations (i.e., test/reference ratio was within $100{\pm}20%$) except for $T_{max}$ The mean of $T_{max}$ showed only 6. 9% difference from the reference but the detection limit was 22.5% which is slightly over the 20% criteria. No pharmacokinetic parameters including Ka, Kel, Vd and Cl indicated significant difference in between the two fomulations. It was concluded that the data yielded fro the two cefriaxone formulations demonstrated that they were bioequivalent.

• Journal of Microbiology and Biotechnology
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• v.28 no.9
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• pp.1563-1572
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• 2018

Gold nanoparticles (AuNP) and their conjugates have been gaining a great deal of recognition in the medical field. Meanwhile, extended-spectrum ${\beta}$-lactamases (ESBL)-producing bacteria are also demonstrating a challenging problem for health care. The aim of this study was the biosynthesis of AuNP using Rosa damascenes petal extract and conjugation of ceftriaxone antibiotic (Cef-AuNP) in inhibiting ESBL-producing bacteria and study of in vitro anticancer activity. Characterization of the synthesized AuNP and Cef-AuNP was studied. ESBL-producing strains, Acinetobacter baumannii ACI1 and Pseudomonas aeruginosa PSE4 were used for testing the efficacy of Cef-AuNP. The cells of MCF-7 breast cancer were treated with previous AuNP and Cef-AuNP at different time intervals. Cytotoxicity effects of apoptosis and its molecular mechanism were evaluated. Ultraviolet-visible spectroscopy and Fourier transform infrared spectroscopy established the formation of AuNP and Cef-AuNP. Transmission electron microscope demonstrated that the formed nanoparticles were of different shapes with sizes of 15~35 nm and conjugation was established by a slight increase in size. Minimum inhibitory concentration (MIC) values of Cef-AuNP against tested strains were obtained as 3.6 and $4{\mu}g/ml$, respectively. Cef-AuNP demonstrated a decrease in the MIC of ceftriaxone down to more than 27 folds on the studied strains. The biosynthesized AuNP displayed apoptotic and time-dependent cytotoxic effects in the cells of MCF-7 at a concentration of $0.1{\mu}g/ml$ medium. The Cef-AuNP have low significant effects on MCF-7 cells. These results enhance the conjugating utility in old unresponsive ceftriaxone with AuNP to restore its efficiency against otherwise resistant bacterial pathogens. Additionally, AuNP may be used as an alternative chemotherapeutic treatment of MCF-7 cancer cells.