Ceftriaxone-induced neutropenia is a rare and severe adverse effect of the drug. It usually resolves in one to three weeks following the cessation of ceftriaxone and the administration of granulocyte colony-stimulating factor (G-CSF). After neutrophil recovery, patients are often treated with non-β-lactam antibiotics instead of ceftriaxone due to the possibility of cross-reactivity associated with β-lactam allergy. However, in some cases, β-lactam antibiotics are superior to non-β-lactam antibiotics. Few cases of the readministration of β-lactam antibiotics for patients who developed ceftriaxone-induced neutropenia have been reported so far. Moreover, its pathogenesis and management have still not been established. We describe a case of successful readministration of β-lactam antibiotics for a patient who had developed ceftriaxone-induced neutropenia. A 37-year-old man with a prosthetic aortic valve was admitted to our hospital with a fever. Blood culture on admission revealed methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, and transesophageal echocardiography (TEE) showed aortic valve vegetation with multiple septic emboli seen on brain CT. We diagnosed MSSA infective endocarditis with central nervous complications. He underwent an operation and was treated with ceftriaxone. On admission day 28, he developed neutropenia (33/μL), and ceftriaxone-induced neutropenia was suspected. Vancomycin was started instead of ceftriaxone, and his neutrophil count recovered within two weeks with the administration of G-CSF. After recovery, on day 40 of admission, ampicillin sodium was administered instead of vancomycin. Although he developed mild eosinophilia, he did not exhibit neutropenia and was discharged with an amoxicillin prescription on day 60 of admission. Our report suggests the possibility that patients who develop ceftriaxone-induced neutropenia can be treated safely with an alternative β-lactam antibiotic, ampicillin sodium, without causing β-lactam cross-reactivity of neutropenia.

Clindamycin-2-phosphate is an injectable preparation of clindamycin which has a high antibacterial activity against gram-positive cocci and anaerobic bacteria. The purpose of the present study was to evaluate the effect of the drug in the clinical treatment of various otorhinolaryngological infection.Fourty-seven out of 64 patients with suppurative otitis media were treated successfully, i.e., evaluated as good or excellent (efficacy rate was 73.4%). Similarly, 15 out of 26 patients with paranasal sinusitis (57.7%), all nine patients with peritonsillar abscess (100%), 14 out of 15 patients with acute tonsillitis (93.3%) and 7 out of 8 patients with other diseases such as acute pharyngitis, etc. (87.5%), were successfully treated.Side effets were observed in one patient with pain at injection site, one with eruption with feeling of pruritus, and one with eruption (incidence of side effect was 2.5%; 4/158). None of the side effects were serious; all of them cleared in 2 to 4 days. Among abnormal laboratory findings observed were an increase in GOT and GPT, urinary protein, an increase in BUN, and leukocytosis; none of them were particularly serious.

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