A Case of Severe Neutropenia From Short-Term Exposure to Moxifloxacin

Abstract

Moxifloxacin is commonly prescribed in the inpatient and outpatient management of community-acquired pneumonia and other common infections. We report a case of a 76-year-old man who developed severe neutropenia after several days of treatment for community-acquired pneumonia. The patient had a history of alcohol abuse; however, there were no other offending medications prescribed, and a thorough laboratory workup for other possible causes of neutropenia was negative. The patient’s neutrophils and white blood count responded quickly to cessation of fluoroquinolones. This case highlights the importance of identifying patients that might be at high risk for neutropenia that may need closer monitoring on this commonly prescribed medication.

Moxifloxacin-associated Neutropenia in a Patient Planned for Renal Transplantation

“…Our patient had findings consistent with moxifloxacin-induced neutropenia. All the three cases which have been reported earlier also had similar presentation[234] [Table 1]. Though reports of ciprofloxacin and norfloxacin-induced neutropenia are available, we could not find any report of cytopenia following levofloxacin administration.…”

Moxifloxacin-induced neutropenia in 26-year-old man

“…He was taken to the hospital by his friends because of fever and cough and moxifloxacin 400 mg/day was startedfor empiric community-acquired pneumonia. Nearly 24 hours after his first dose of moxifloxacin, hisWBC decreased by nearly 50% and continued to decreaseeach day until the moxifloxacin was stopped [4].…”

“…The mechanism of leukopenia and neutropenia induced with moxifloxacin therapy is unclear. Neutropenia occurs usually either from failure of production of neutrophils in the bone marrow or from their peripheral destruction [4]. There are multiple congenital and acquired causes of neutropenia due to infections (especially viral infections), nutritional deficiencies, immune reactions and drug therapy [3].…”

“…Moxifloxacin, inhibiting ATP-dependent enzymes topoisomerase II (DNA gyrase) and topoisomerase IV, is a fourth generation widely used fluoroquinolone antibiotic [1,2]. Moxifloxacin with potent activity against gram-positive, gram-negative and atypical bacteria is generally being used for the treatment of community-acquired pneumonia (CAP) and widely used in urinary system, digestive system and other infections [1,3,4]. It is also used in neutropenic patients for the treatment of infections [5].Common adverse effects are nausea, diarrhea and dizziness.…”

“…It is also used in neutropenic patients for the treatment of infections [5].Common adverse effects are nausea, diarrhea and dizziness. QT prolongation, fatal arrhythmias and liver injury are uncommon adverse effects [4,6].…”