An antibiotic used intravenously to treat Lyme disease encephalopathy has been linked to kidney failure in children.
According to a retrospectice study published in the journal Pediatrics this week, the antibiotic may cause pediatric acute renal failure (PARF) in children, connected to the formation of kidney stones and other issues with the renal system.
Ceftriaxone is an antibiotic commonly used to treat infections in kids, and may be used in cases of neuroborreliosis where doxycycline and other more typical Lyme disease antibiotics are contraindicated or have failed to eradicate the infection. Although rare, physicians should be aware of the potential for PARF in pediatric patients they are treating with intravenous ceftriaxone in order to ensure early diagnosis and treatment to relieve the condition.
Typically, children with acute kidney failure will be treated with medications including anisodamine, sodium bicarbonate, antibiotics, albumen, and low-dose dexamethasone. Where such interventions fail to resolve the condition, children may be catheterised. In this latest study, all of the children eventually recovered, although one child had to go through three rounds of hemodialysis as pharmacological treatment and catheterisation failed to resolve the issue.
Acute Renal Failure After 5 Days of Ceftriaxone Treatment
The renal failure occured an average of just over five days after children began treatment with ceftriaxone, with symptoms such as sudden-onset of anuria (not passing water) for at least 24 hours. Other symptoms included flank pain, excessive crying, and vomiting. The children were examined using ultrasound and calculi were found in the urinary tract in 11 of the 31 patients assessed in the study. Mild hydronephrosis was seen in 25 of the children.
Kidney Failure in Adults Treated with Ceftriaxone
Ceftriaxone has been linked to biliary pseudolithiasis, nephrolithiasis, and bladder sludge, as well as urinary crystal formation in adults that could lead to acute renal failure. Reports of renal failure in children prescribed ceftriaxone are rare, however. In this study, the children had an average age of 5.1 years. Nine of the children recovered after 1 to 4 days of medications for PARF, with all but one of the others recovering after catheterisation. The child who failed to get better after pharmacological treatment and for whom catheterisation was impeded due to dense calculi, underwent three sessions of hemodialysis, after which urinary function returned.
Interestingly, because this study was carried out in China, some of the medications used to treat the children are unavailable in the US, making it difficult to generalise regarding prognosis. For example, the antispasmodic used to treat the children is a traditional Chinese herbal medicine.
Four of the children had calculi recovered, and analysis of the stones found that the antibiotic, ceftriaxone, formed the major part of these stones. Recovering ceftriaxone stones is made difficult by the texture of these stones, however. Children suspected of ceftriaxone-induced PARF associated with Lyme disease treatment do well if diagnosed and treated promptly.
Reducing the Risk of Kidney Failure with Lyme Disease Antibiotic
Additionally, both adults and children treated with ceftriaxone for Lyme disease should be advised to ensure good hydration in order to maintain urinary flow, and to avoid the use of calcium supplements during treatment, as well as to eat a low-sodium diet. The use of thiazide diuretics may also be helpful, although with Lyme disease causing a range of potential psychological symptoms it may be difficult to ensure adherence to such a regime without hospitalisation.
Li, N., Zhou, X., Yuan, J., Chen, G., Jiang, H., Zhang, W. (2014). Ceftriaxone and Acute Renal Failure in Children. Pediatrics. 2014 Mar 24.