Bone Marrow Suppression: A Side Effect of Ciprofloxacin Therapy

Chaudhry, Muhammad; Tarneja, Neel; Gundale, Abhijit; Roa, Denise; Levey, Robert

doi:10.1097/mjt.0b013e3181a4695f

Cited by 13 publications

(7 citation statements)

References 6 publications

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“…As the knowledge regarding timing of ciprofloxacin- and piperacillin/tazobactam-induced thrombocytopenia is based on case reports, it is not possible to reliable estimate the time course of thrombocytopenia from that review. However, interestingly, several other published reports regarding antimicrobial-induced thrombocytopenia describes decreasing platelet count and development of thrombocytopenia within 4 days after exposure to ciprofloxacin [15,18-20] and piperacillin/tazobactam [21-23] consistent with our findings. The great diversity in timing is most likely explained by varying mechanisms causing drug-induced thrombocytopenia [7,10],including that prior exposure may have already sensitised some patients leading to more rapid effects upon reexposure [13].…”

Section: Discussionsupporting

confidence: 92%

The Potential of Antimicrobials to Induce Thrombocytopenia in Critically Ill Patients: Data from a Randomized Controlled Trial

et al. 2013

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BackgroundAntimicrobial-induced thrombocytopenia is frequently described in the literature among critically ill patients. Several antimicrobials have been implicated, although experimental evidence to demonstrate causality is limited. We report, using a randomized trial, the potential of antimicrobials to induce thrombocytopenia.MethodsRandomized trial allocated patients to antimicrobial treatment according to standard- of-care (SOC group) or drug-escalation in case of procalcitonin increases (high-exposure group). Patients were followed until death or day 28. Thrombocytopenia defined as absolute (platelet count ≤100x109/L) or relative (≥20% decrease in platelet count). Analyses were performed in the two randomized groups and as a merged cohort. ResultsOf the 1147 patients with platelet data available, 18% had absolute thrombocytopenia within the first 24 hours after admission to intensive care unit and additional 17% developed this complication during follow-up; 57% developed relative thrombocytopenia during follow-up. Absolute and relative thrombocytopenia day 1-4 was associated with increased mortality (HR: 1.67 [95% CI: 1.30 to 2.14]; 1.71 [95% CI: 1.30 to 2.30], P<0.0001, respectively). Patients in the high-exposure group received more antimicrobials including piperacillin/tazobactam, meropenem and ciprofloxacin compared with the SOC group, whereas cefuroxime was used more frequently in the SOC group (p<0.05). Risk of absolute and relative thrombocytopenia (RR: 0.9 [0.7-1.3], p=0.7439; 1.2 [1.0-1.4], p=0.06; respectively), as well as absolute platelet count (daily difference, high-exposure vs. SOC -1.7 [-3.8-0.5], p=0.14) was comparable between groups. In observational analyses, use of ciprofloxacin and piperacillin/tazobactam predicted risk of relative thrombocytopenia (vs. cefuroxime, RR: 2.08 [1.48-2.92]; 1.44 [1.10-1.89], respectively), however only ciprofloxacin were associated with a reduction in absolute platelet count (p=0.0005). ConclusionHigh exposure to broad-spectrum antimicrobials does not result in a reduction in thrombocytopenia in critically ill patients. However, single use of ciprofloxacin, and less so piperacillin/tazobactam, may contribute to a lower platelet count.Trial Registration ClinicalTrials.gov NCT00271752 http://clinicaltrials.gov/ct2/show/NCT00271752

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Section: Discussionsupporting

confidence: 92%

The Potential of Antimicrobials to Induce Thrombocytopenia in Critically Ill Patients: Data from a Randomized Controlled Trial

et al. 2013

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“…This patient made a successful recovery after the ciprofloxacin was stopped. 2 In conclusion, our case highlights a very rare side effect of ciprofloxacin, and hence, health care providers should watch out for this potential adverse effect when prescribing ciprofloxacin.…”

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confidence: 69%

Ciprofloxacin-Associated Pancytopenia: A Rare Side Effect of a Commonly Prescribed Medication

Rabbi

Qayum

Humayun

et al. 2021

American Journal of Therapeutics

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“…Tuccori et al [4] observed abdominal pain, hepatitis, thrombocytopenia, and hemolysis in a 30-year-old patient after ciprofloxacin treatment for urinary tract infection. In addition to this, Chaudhry et al [5] observed that thrombocytopenia occurred as a result of ciprofloxacin treatment for urinary tract infection.…”

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confidence: 94%