An unusual case of piperacillin-tazobactam-induced fever, eosinophilia, thrombocytopenia and liver damage

Lv, Jitao; Wu, Guannan; Zhang, Fang; Su, Xin

doi:10.1136/ejhpharm-2020-002575

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Neutropenia and thrombocytopenia being the most common hematological adverse reactions ( 10 , 11 ). However, the presence of fever caused by an allergic reaction has also been reported ( 12 ), whereas a rare case of fever, eosinophilia and liver injury caused by piperacillin-tazobactam treatment has been documented in another case ( 13 ). Furthermore, Jafri et al ( 14 ) reported a case of induced hypersensitivity myocarditis, a rare complication of drug-related myocardial injury, following the use of piperacillin-tazobactam.…”

Section: Discussionmentioning

confidence: 99%

Piperacillin‑tazobactam‑induced myocardial injury with heart failure: A case report

Liu,

An,

et al. 2024

Exp Ther Med

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Piperacillin-tazobactam is a clinically used antibiotic consisting of the semisynthetic penicillin piperacillin and the β-lactamase inhibitor tazobactam. Piperacillin-tazobactam is a broad-spectrum antibiotic used clinically to treat infections caused by gram-positive and gram-negative aerobic and anaerobic bacteria. The most common adverse reactions are gastrointestinal symptoms and skin reactions. There have been a few reported cases of possible drug hypersensitivity, with thrombocytopenia as the most commonly observed adverse event. The present article reported a rare case of myocardial injury with heart failure following treatment of pneumonia with piperacillin-tazobactam in a 75-year-old female patient. Specifically, this patient presented with fever, chills, flushing and tachypnea, in addition to elevated leukocyte, neutrophil, cardiac enzyme and brain natriuretic peptide levels. This patient also presented with a mild ST-segment elevation on the electrocardiogram following piperacillin-tazobactam treatment. Improvements in the aforementioned adverse reactions were observed and the underlying infection didn't come back following the discontinuation of piperacillin-tazobactam treatment. Therefore, the present observations suggest that piperacillin-tazobactam may have induced myocardial injury and heart failure. Possible occurrence of similar adverse reactions in the heart should be considered before choosing piperacillin-tazobactam as treatment in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Piperacillin‑tazobactam‑induced myocardial injury with heart failure: A case report

Liu,

An,

et al. 2024

Exp Ther Med

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“…Another study evidenced that piperacillin-tazobactam hypersensitivity reactions were present in the study participants [17] . Another study also showed that there are long-term side effects of these drugs as well [18] .…”

Section: Table-iii: Hypersensitivity Reaction Among Male Andmentioning

confidence: 95%

Prevalence of Piperacillin-Tazobactam induced Hypersensitivity Reaction in Workers of Stallion’s Pharmaceutical Factory at Lahore

Sulehri¹,

Yaqub

Imam

et al. 2022

JUMDC

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BACKGROUND & OBJECTIVE: Piperacillin is an antibiotic that belongs to the ureidopenicillin family. Piperacillin-tazobactam provides cover against gram-positive, gram-negative bacteria and some bacteria of anaerobic nature. It is an extended-spectrum antibiotic and is used along with tazobactam which is an inhibitor of beta-lactamase. The main objective of our research was to identify the hypersensitivity reactions of piperacillin-tazobactam in pharmaceuticals factory and office workers. METHODOLOGY: A Cross-sectional study was conducted at Stallion Pharmaceuticals (Pvt) Ltd located at Sundar Industrial Estate Lahore, Pakistan, from March to April 2018, after approval from the institutional research committee. All the workers, including factory workers and office workers at Stallion Pharmaceuticals (Pvt) Ltd were included in this study. Data was collected from each respondent by immediate-type skin testing. Data analysis was done by SPSS version 25, the demographic data was evaluated by descriptive statistics, Fisher Exact test was used for comparison and p≤0.05 was taken as significant. RESULTS: The results of the study presented that hypersensitivity reaction was present in (7.5%) of males and (3.8%) of females. It was also observed that (8.8%) of factory workers had hypersensitivity reactions when they are gone through skin tests, and only (2.5%) of office workers were skin test positive. From the above results (11.2%) of all the respondents developed hypersensitivity reactions and (88.8%) showed no reaction when they were gone through skin tests, which contain 0.1 ml of piperacillin and tazobactam. Fisher exact test was applied, and results showed no significant difference between hypersensitivity reactions among factory and office workers as the p-value was 01. CONCLUSION: Hypersensitivity reaction to piperacillin-tazobactam was minimal in the factory & office workers, and this was not significant.

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“…66 Bone marrow suppression with hepatic injury has been described as well. 67 68 More serious reactions including ascites formation and bile cast nephropathy leading to eventual liver and kidney transplantation have been reported. 69 Of note, P-T is associated with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, a severe drug hypersensitivity reaction.…”

Section: Antibioticsmentioning

confidence: 99%

Hepatotoxicity of Antibiotics and Antifungals and Their Safe Use in Hepatic Impairment

Ma,

Björnsson,

Chalasani

2024

Semin Liver Dis

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Idiosyncratic drug-induced liver injury (DILI) is a rare and unpredictable form of hepatotoxicity. While its clinical course is usually benign, cases leading to liver transplantation or death can occur. Based on modern prospective registries, antimicrobials including antibiotics and antifungals are frequently implicated as common causes. Amoxicillin–clavulanate ranks as the most common cause for DILI in the Western World. Although the absolute risk of hepatotoxicity of these agents is low, as their usage is quite high, it is not uncommon for practitioners to encounter liver injury following the initiation of antibiotic or antifungal therapy. In this review article, mechanisms of hepatoxicity are presented. The adverse hepatic effects of well-established antibiotic and antifungal agents are described, including their frequency, severity, and pattern of injury and their HLA risks. We also review the drug labeling and prescription guidance from regulatory bodies, with a focus on individuals with hepatic impairment.

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An unusual case of piperacillin-tazobactam-induced fever, eosinophilia, thrombocytopenia and liver damage

Cited by 8 publications

References 18 publications

Piperacillin‑tazobactam‑induced myocardial injury with heart failure: A case report

Piperacillin‑tazobactam‑induced myocardial injury with heart failure: A case report

Prevalence of Piperacillin-Tazobactam induced Hypersensitivity Reaction in Workers of Stallion’s Pharmaceutical Factory at Lahore

Hepatotoxicity of Antibiotics and Antifungals and Their Safe Use in Hepatic Impairment

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