The formation of biliary sludge and cholelithiasis after ceftriaxone administration is not uncommon. Prompt resolution of sludge has been demonstrated with discontinuation of the drug. Despite this, cholecystectomy has been performed in symptomatic patients. Ceftriaxone is popular drug in pediatrics, but the complication is not widely appreciated in the gastroenterology and surgical literature. For this adverse effect and for cost ceftriaxone should be used with more caution. We describe two cases of children with ceftriaxone induced cholelithiasis.