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Holz JM, Chevtchenko AV, Aitullina A. Acute antibiotically induced neutropenia: A systematic review of case reports. Br J Clin Pharmacol 2021; 88:1978-1984. [PMID: 34897762 DOI: 10.1111/bcp.15170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/20/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS Acute neutropenia induced by antibiotics is a rare side effect of this frequently prescribed class of drugs. We aim to find similarities and differences between reported cases. METHODS Through a database search (PubMed, 1968-2020), we identified published case reports and extracted, among other data, patient demographics, duration of treatment with the respective agent, and duration of recovery. RESULTS Overall, 83 cases were included. Neutropenia developed after a median (min-max) of 21 (17.5-28.5) days of treatment and was resolved after a median (min-max) of 6 (3.0-8.75) days. Vancomycin and ceftaroline emerged as the two most commonly described antibiotics. In 51.8% of cases, the suspected antibiotic was discontinued; in 37.4% of cases, it was substituted by another agent. Only three case reports mentioned death as a result of neutropenia. The use of granulocyte colony-stimulating growth factors (CSFs) shortened the duration of neutropenia and improved outcome for patients' health. CONCLUSION Neutropenia induced by antibiotics remains a rare or rarely reported side effect. Long-term and high-dose treatment regimens expose a higher risk of development. Thus, regular full blood counts are advised during therapy.
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Affiliation(s)
- Julian M Holz
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
| | | | - Aleksandra Aitullina
- Department of Pharmacology, Paul Stradins Clinical University Hospital, Riga Stradins University, Riga, Latvia
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Cimino C, Allos BM, Phillips EJ. A Review of β-Lactam-Associated Neutropenia and Implications for Cross-reactivity. Ann Pharmacother 2020; 55:1037-1049. [PMID: 33215507 DOI: 10.1177/1060028020975646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To review the incidence, management, and current understanding of the pathophysiology of β-lactam-induced neutropenia and to critically evaluate the practicality and safety of direct substitution to an alternative β-lactam in the setting of this reaction. DATA SOURCES A literature analysis using the PubMed and Ovid search engines (July 1968 to October 2020) was performed using the search terms neutropenia, leukopenia, β-lactam, nonchemotherapy, agranulocytosis, and G-CSF (granulocyte colony-stimulating factor). STUDY SELECTION AND DATA EXTRACTION The included English-language studies evaluated the incidence, mechanism, and/or management of β-lactam-induced neutropenia in pediatric or adult patients. DATA SYNTHESIS Drug-induced neutropenia is a well-documented adverse reaction of β-lactam antibiotics, with an incidence of approximately 10% following at least 2 weeks of intravenous therapy. However, multiple gaps in knowledge remain in the mechanism of pathophysiology and optimal management of this reaction. Both direct toxic and immune-mediated mechanisms have been implicated. Although the cornerstone of management includes cessation of the offending agent, controversy exists on the appropriateness of direct substitution or future use of an alternative β-lactam. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Given the frequency of use and superiority of β-lactams over alternative therapy for several infectious disease states, practical recommendations are needed on the management and safe use of β-lactams following β-lactam-induced neutropenia. CONCLUSION Future use of β-lactams with differing R1 side chains, particularly those from a separate class, should not be deemed contraindicated following β-lactam-induced neutropenia and may be considered when indicated, with close laboratory monitoring.
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Affiliation(s)
- Christo Cimino
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ban M Allos
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth J Phillips
- Vanderbilt University Medical Center, Nashville, TN, USA.,Murdoch University, Murdoch, WA, Australia
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Hematologic adverse effects induced by piperacillin-tazobactam: a systematic review of case reports. Int J Clin Pharm 2020; 42:1026-1035. [PMID: 32500262 DOI: 10.1007/s11096-020-01071-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Background Piperacillin/tazobactam, a semisynthetic antibiotic, is widely used to treat polymicrobial infections. Its hematologic adverse reactions are rare and the severity can be mild to life-threatening. To our knowledge, there has not been a publication reviewing hematologic abnormalities attributable to piperacillin/tazobactam. Aim of the review To evaluate the characteristic, clinical identification, mechanism and treatment of the hematologic toxicity caused by piperacillin/tazobactam. Method A search of Medline and Embase electronic databases was performed for case reports of adverse reactions of hematologic system related to piperacillin/tazobactam from inception to December 2018. Statistical analysis of demographic, clinical features, laboratory Indexes and treatments was performed using Microsoft EXCEL 2007. Results Fifty-nine references were obtained involving 62 patients. The adverse drug reactions were mainly hemolytic anemia (25, 40.3%), thrombocytopenia (23, 37.1%), and neutropenia (12, 19.4%), which might be accompanied by some typical symptoms. Hemolytic anemia or thrombocytopenia was generally believed to be immune-mediated and often appeared within 10 days, and neutropenia was thought to be related to bone marrow suppression and usually occurred 2 weeks after the initiation of piperacillin/tazobactam. Most patients improved or recovered within a week with treatment or not, and fewer high-quality evidence-based treatments were identified. Conclusion Although part of the patients have clinical symptom, the hematologic adverse drug reactions of piperacillin/tazobactam are easily overlooked or misdiagnosed. Take special caution for patients with prolonged piperacillin/tazobactam treatment or specific disease, and prompt recognition and treatment of the adverse drug reactions are essential and can hasten recovery regardless of the type of side reactions.
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Fry W, McCafferty S, Gooday C, Nunney I, Dhatariya KK. Assessing the Effect of Piperacillin/Tazobactam on Hematological Parameters in Patients Admitted with Moderate or Severe Foot Infections. Diabetes Ther 2018; 9:219-228. [PMID: 29302933 PMCID: PMC5801243 DOI: 10.1007/s13300-017-0357-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Piperacillin/tazobactam is a commonly used antibiotic for the empirical treatment of severe diabetic foot infections. One of the most feared complications of this drug is the development of pancytopenia. The aim of this study was to determine whether the use of piperacillin/tazobactam caused any hematological changes in patients admitted with severe diabetes-related foot infections from a specialist multidisciplinary foot clinic. Specifically, looking at whether it caused anemia, leukopenia, neutropenia, or thrombocytopenia. METHODS A 1-year retrospective analysis of patients admitted to a tertiary care center for treatment of diabetes-related foot infection using piperacillin/tazobactam. Hematological indices, urea and electrolytes, and C-reactive protein (CRP) were recorded pretreatment, during treatment, and posttreatment. HbA1c, vitamin B12, folate, thyroid-stimulating hormone, and free thyroxin were also analyzed to exclude any potential confounders as a cause of pancytopenia. RESULTS A total of 154 patients were admitted between 1 January 2016 and 31 December 2016 who received piperacillin/tazobactam for severe diabetes-related foot infection. On admission, white cell count and CRP were raised and fell significantly within the first 48 h. Other hematological factors did not change. Five patients developed a mild pancytopenia, of which three were unexplained. CONCLUSION In this relatively small cohort, pancytopenia did not occur. As such, piperacillin/tazobactam appeared to have a low risk of adverse hematological outcomes and remains the treatment of choice for severe diabetes-related foot infections.
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Affiliation(s)
- Will Fry
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Sean McCafferty
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Catherine Gooday
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - Ian Nunney
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Ketan K Dhatariya
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
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Lemieux P, Gregoire JP, Thibeault R, Bergeron L. Higher Risk of Neutropenia Associated With Piperacillin-Tazobactam Compared With Ticarcillin-Clavulanate in Children. Clin Infect Dis 2014; 60:203-7. [DOI: 10.1093/cid/ciu780] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Griffith M, Postelnick M, Scheetz M. Antimicrobial stewardship programs: methods of operation and suggested outcomes. Expert Rev Anti Infect Ther 2014; 10:63-73. [DOI: 10.1586/eri.11.153] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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He ZF, Wu XA, Wang YP. Severe bone marrow suppression and hepatic dysfunction caused by piperacillin/tazobactam. ACTA ACUST UNITED AC 2013; 45:885-7. [DOI: 10.3109/00365548.2013.805426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lin SY, Huang JC, Shen MC, Chuang SH, Lee MH, Chen HC. Piperacillin-induced thrombocytopenia reversed by high-flux hemodialysis in an uremic patient. Hemodial Int 2013; 16 Suppl 1:S50-3. [PMID: 23036037 DOI: 10.1111/j.1542-4758.2012.00745.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Drug-induced thrombocytopenia in an infected patient often is overlooked. We present a 74-year-old uremic female with continuous renal replacement therapy developed severe thrombocytopenia during the treatment course of piperacillin/tazobactam. Platelet counts recovered rapidly after discontinuing piperacillin/tazobactam and receiving high-flux hemodialysis. The George criteria indicates piperacillin/tazobactam as the probable cause of thrombocytopenia in this patient. Immediate withdrawal of the causative drug is important for drug-induced thrombocytopenia. Prompt high-flux hemodialysis may be an adjunctive management for uremic patients.
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Affiliation(s)
- Shang-Yi Lin
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Uzun G, Önem Y, Hatipoglu M, Turhan V, Mutluoglu M, Ay H. Piperacillin/tazobactam-induced neutropenia, thrombocytopenia, and fever during treatment of a diabetic foot infection. ACTA ACUST UNITED AC 2012; 45:73-6. [DOI: 10.3109/00365548.2012.697638] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Scheetz MH, McKoy JM, Parada JP, Djulbegovic B, Raisch DW, Yarnold PR, Zagory J, Trifilio S, Jakiche R, Palella F, Kahn A, Chandler K, Bennett CL. Systematic Review of Piperacillin-Induced Neutropenia. Drug Saf 2007; 30:295-306. [PMID: 17408306 DOI: 10.2165/00002018-200730040-00002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Because penicillin agents are implicated in granulopoiesis inhibition, healthcare professionals frequently consider discontinuation of such therapy in patients with decreasing white blood cell counts. No systematic review to date has described piperacillin and the patient population at risk for this adverse drug reaction (ADR). This review sought to assess the occurrence of piperacillin-induced neutropenia, describe characteristics of affected patients and assess the reporting modalities that most accurately classify this ADR. Case reports, cohort studies and clinical trials identified by comprehensive searches of PubMed and the US FDA Adverse Event Reporting System (AERS) database were reviewed for patient demographics, duration and dose of piperacillin or piperacillin-tazobactam treatment and the occurrence of neutropenia. Causality assessments were performed. Six published case reports, three cohort studies, 178 clinical trials and two compilations of phase I-III trials were reviewed. Review of case reports was notable in that the duration of beta-lactam therapy prior to the noting of leukopenia always exceeded 15 days. No deaths were recorded in this group. Among 13,816 patients enrolled in non-neutropenic fever studies, the occurrence of piperacillin-induced neutropenia was rare: five patients (0.04%) developed neutropenia; none died. The demographics for this group were poorly documented. Through the AERS database, we identified 366 unique cases of piperacillin or piperacillin-tazobactam-induced haematological abnormalities, including neutropenia (n = 183, 50.0%), leukopenia, (n = 99, 27%), agranulocytosis (n = 58, 15.8%) and others. In 62 cases, patients received between 1 and 14 days of therapy (mean 7.7 + 4.1 days). Overall, there were 82 (22.4%) deaths. Reports of haematological ADRs among patients receiving piperacillin or piperacillin-tazobactam are rare. Report of neutropenia associated with piperacillin usage prior to 15 days of therapy is a novel finding that requires further evaluation. Current reporting methods poorly characterise patient groups at risk.
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Affiliation(s)
- Marc H Scheetz
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Il 60611, USA
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Bette M, Nüsing RM, Mutters R, Zamora ZB, Menendez S, Schulz S. Efficiency of tazobactam/piperacillin in lethal peritonitis is enhanced after preconditioning of rats with O3/O2-pneumoperitoneum. Shock 2006; 25:23-9. [PMID: 16369182 DOI: 10.1097/01.shk.0000187983.56030.dd] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Insufflation of ozonized oxygen into the peritoneum (O3/O2-pneumoperitoneum [O3/O2-PP]) of rats reduced the lethality of peritonitis. We evaluated the prophylactic effect of O3/O2-PP combined with tazobactam/piperacillin (TZP) in polymicrobial lethal peritonitis. Wistar rats were conditioned by daily repeated insufflation of ozone for 5 days, and hematologic parameters were determined. Sepsis was induced by i.p. injection of cecal material derived from donor rats. Simultaneously, TZP was applied at a single dosage of 65 mg/kg or at two dosage schedules of 65 mg/kg each at an interval of 1 h. The conditioning effect of O3/O2-PP on the number of blood cells was measured before inoculation of bacteria. The mRNA levels of proinflammatory cytokine IL-lbeta and TNF-alpha were determined at 4 h post infection in spleen and liver by semiquantitative in situ hybridization analysis. Preconditioning of rats by O3/O2-PP enhanced the number of blood leukocytes and granulocytes and increased the survival rate of septic rats up to 33%. The combination of O3/O2-PP and TZP further enhanced the survival rate up to 93%. This effect was accompanied by a reduced amount of IL-1beta and TNF-alpha mRNA in spleen and liver. In contrast, in non-infected animals the combination of O3/O2-PP and TZP enhanced IL-1beta and TNF-alpha mRNA in the spleen and IL-1beta mRNA in liver when compared with TZP- and sham-treated controls. The preconditioning effect of O3/O2-PP seems to support the biological effectiveness of TZP by altering the immune status before and during the onset of sepsis. The combined therapy could be a simple, preoperative intervention for abdominal surgery to reduce postoperative morbidity and mortality.
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Affiliation(s)
- Michael Bette
- Institute of Anatomy and Cell Biology, Philipps-University of Marburg, Marburg 35033, Germany
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Lambourne J, Kitchen J, Hughes C, Merry C. Piperacillin/tazobactam-induced paresthesiae. Ann Pharmacother 2006; 40:977-9. [PMID: 16622157 DOI: 10.1345/aph.1g526] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe a case of a delayed-type hypersensitivity (DTH) reaction to piperacillin/tazobactam in which painful paresthesiae were a predominant feature. CASE SUMMARY A 27-year-old man with a history of intravenous drug abuse was admitted for treatment of a pulmonary parenchymal abscess in the setting of lower-limb deep-venous thrombosis and methicillin-sensitive Staphylococcus aureus bacteremia. He was treated with intravenous piperacillin/tazobactam 4.5 g 3 times daily; however, after 2 weeks of therapy, he developed symptoms (eg, fever, chills) and laboratory abnormalities (eg, white blood cell count 2.1 x 10(3)/mm3, erythrocyte sedimentation rate 63 mm/h) suggestive of a DTH reaction. This was accompanied by infusion-related painful paresthesiae. The symptoms and laboratory abnormalities resolved within 48 hours of treatment being switched to flucloxacillin. DISCUSSION Due to the close temporal association and the absence of any other obvious explanation, we believe these paresthesiae represent an additional feature of the DTH reaction to piperacillin/tazobactam in this patient. Use of the Naranjo probability scale indicated a probable relationship between the paresthesiae and administration of piperacillin/tazobactam. CONCLUSIONS To our knowledge, as of March 24, 2006, this is the first case in which a DTH reaction to piperacillin/tazobactam manifesting as fever, neutropenia, and thrombocytopenia has been associated with paresthesiae.
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Affiliation(s)
- Jonathan Lambourne
- Department of Infectious Disease and Genitourinary Medicine, St James's Hospital, Dublin, Ireland.
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Peralta G, Sánchez-Santiago MB. Neutropenia secundaria a betalactámicos. Una vieja compañera olvidada. Enferm Infecc Microbiol Clin 2005; 23:485-91. [PMID: 16185564 DOI: 10.1157/13078841] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Beta-lactam-induced neutropenia has been a well-recognized problem since the initiation of penicillin use. It generally develops following high-dose beta-lactam treatment lasting longer than 10 days, and its frequency rises with increases in the cumulative antibiotic dose. Beta-lactam-induced neutropenia is frequently preceded by fever or rash, which can be considered alarm signs. Unlike neutropenia induced by other nonchemotherapy drugs, beta-lactam-induced neutropenia usually lasts less than 10 days and infrequently causes infectious complications or death. Although any beta-lactam agent can cause neutropenia, recent studies have focused on cases of piperacillin-tazobactam- or cefepime-induced neutropenia; a high incidence of neutropenia has been demonstrated during prolonged treatment with these antibiotics. The apparent contradiction with the results of clinical trials that did not detect this complication is due to the fact that they involved treatments shorter than two weeks. The potential for the development of neutropenia during lengthy intravenous treatment should be borne in mind in the development of new beta-lactams.
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Affiliation(s)
- Galo Peralta
- Servicio de Medicina Interna, Hospital Sierrallana, Torrelavega, Santander, Spain.
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Peralta FG, Sánchez MB, Roíz MP, Pena MA, Tejero MA, Arjona R. Incidence of Neutropenia during Treatment of Bone-Related Infections with Piperacillin-Tazobactam. Clin Infect Dis 2003; 37:1568-72. [PMID: 14614681 DOI: 10.1086/379519] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2003] [Accepted: 07/20/2003] [Indexed: 11/04/2022] Open
Abstract
Of 41 patients with bone-related infections who were treated for > or =10 days with piperacillin-tazobactam, 14 (34%) developed neutropenia. Cumulative doses of piperacillin administered to neutropenic patients were higher than those administered to nonneutropenic ones (330 vs. 237 g; P=.008), and an inverse correlation was detected between the absolute neutrophil count at the end of treatment and the cumulative dose of piperacillin (r=-0.47, P=.002). Moreover, the incidence of piperacillin-tazobactam-induced neutropenia increased with an increase in the cumulative dose of piperacillin: 0% of patients in the first quartile of cumulative piperacillin doses, 33.3% in the second quartile, 40% in the third quartile, and 66.7% in the fourth quartile.
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Affiliation(s)
- F G Peralta
- Internal Medicine, Sierrallana Hospital, Torrelavega, Spain.
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Kumar A, Choudhuri G, Aggarwal R. Piperacillin induced bone marrow suppression: a case report. BMC CLINICAL PHARMACOLOGY 2003; 3:2. [PMID: 12791166 PMCID: PMC165417 DOI: 10.1186/1472-6904-3-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 06/05/2003] [Indexed: 01/18/2023]
Abstract
BACKGROUND Piperacillin (and piperacillin/tazobactam) is a commonly prescribed antibiotic and is generally considered safe. We report a case of piperacillin induced bone marrow suppression. CASE PRESENTATION A 19-year-old boy was being treated with piperacillin followed by piperacillin/tazobactam for infected pancreatic pseudocyst. After 21 days of treatment, he developed neutropenia and thrombocytopenia. These reversed promptly after stopping piperacillin/tazobactam. The time course of events suggested that piperacillin was the cause of bone marrow suppression in this patient. CONCLUSION Bone marrow suppression is a serious adverse effect of piperacillin, which should be kept in mind while treating patients with this drug.
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Affiliation(s)
- Ashish Kumar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India
| | - Gourdas Choudhuri
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India
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Gore C, David TJ. Drug-Induced Fever and Bone Marrow Suppression in a 12-Year-Old Girl with Cystic Fibrosis. Med Chir Trans 2001; 94 Suppl 40:35-7. [PMID: 11601163 PMCID: PMC1310585 DOI: 10.1177/014107680109440s09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C Gore
- Royal Albert Edward Infirmary, Wigan WN1 2NN, UK
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Glauser M. Empiric therapy of bacterial infections in patients with severe neutropenia. Diagn Microbiol Infect Dis 1998; 31:467-72. [PMID: 9635238 DOI: 10.1016/s0732-8893(98)00038-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The urgent need to treat presumptive infections in neutropenic patients has meant that initial therapy is empiric based on the pathogens most likely to be responsible for the patient's rise in temperature or other symptoms of infection. The spectrum of causative pathogens has changed over time and reflects the availability and use of antimicrobial agents. Gram-positive organisms predominated in the 1940s and onward until the widespread use of early penicillins and cephalosporins effectively addressed this problem. The upsurge in infections in the 1970s and 1980s caused by Gram-negative organisms, particularly Pseudomonas aeruginosa, Escherichia coli and Klebsiella spp., has been supplanted by a new wave of infections caused by Gram-positive organisms, this time predominantly Staphylococcus aureus, Staphylococcus epidermidis, and the viridans streptococci. The fourth-generation cephalosporins (cefpirome) among other broad-spectrum beta-lactams, by virtue of their enhanced antimicrobial activity against Gram-positive pathogens and greater beta-lactamase stability, are promising candidates for use in the empiric management of febrile episodes in neutropenic patients. Early clinical trial results are promising and should lead the way for further use of these compounds in this indication.
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Affiliation(s)
- M Glauser
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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