Ceftriaxone-induced Agranulocytosis

Couto, Lénio; Goulart, André; Valadão, Ivone Melo; Garça, Magda; Santos, Maria Beatriz; Cota, Pedro; Teixeira, Carolina

doi:10.12890/2021_002215

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…However, since only one dose was given approximately 19 days before presenting with agranulocytosis, it would be highly unlikely that this contributed given the existing literature that ceftriaxone-induced agranulocytosis occurs after prolonged courses with high cumulative doses. 19,20 Also, this patient had a bone marrow biopsy and hematologist evaluation which helped to confirm a diagnosis of drug-induced agranulocytosis strengthening this case as a probable representation of sulfamethoxazole/trimethoprim IDIA.…”

Section: Discussionmentioning

confidence: 82%

Agranulocytosis Associated With Use of Sulfamethoxazole/Trimethoprim in a Healthy Adult

Bunch

Brands

Langworthy

2022

Journal of Pharmacy Practice

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Purpose: A case of sulfamethoxazole/trimethoprim-induced agranulocytosis is reported. Summary: A 53-year-old healthy male presented to the emergency room with a fever of 102.7°F and was found to have a white blood cell (WBC) count of 0.6 × 103 cells/μL with an absolute neutrophil count (ANC) of 0.0 x 103 cells/μL. He had recently completed a 10-day course of sulfamethoxazole/trimethoprim for left lower extremity cellulitis. During admission, a bone marrow biopsy was performed which was not concerning for malignancy and no cause for the agranulocytosis other than the sulfamethoxazole/trimethoprim was identified. The agranulocytosis resolved after 6 days of hospitalization with a WBC count of 8.9 × 103 cells/μL and an ANC of 4.1 x 103cells/μL on the day of discharge. Conclusion: A 53-year-old male developed agranulocytosis after 10 days of sulfamethoxazole/trimethoprim therapy for the treatment of a skin and soft tissue infection. His neutropenia resolved after sulfamethoxazole/trimethoprim discontinuation.

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Section: Discussionmentioning

confidence: 82%

Agranulocytosis Associated With Use of Sulfamethoxazole/Trimethoprim in a Healthy Adult

Bunch

Brands

Langworthy

2022

Journal of Pharmacy Practice

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“…The R1 chain is attached to the β-lactam ring, and the R2 chain is attached to the cefepime ring [ 17 ]. Couto et al reported that the alternative administration of cefepime with identical R1 chains for a patient with ceftriaxone-induced neutropenia did not cause allergic reactions, including neutropenia, suggesting that neutropenia is assumed to originate from the R2 chain if the pathogenesis involves immunologic reactions [ 6 ]. Penicillin and cephalosporines have different R1 chains and share only a common 4-membered β-lactam ring.…”

Section: Discussionmentioning

confidence: 99%

“…Ceftriaxone-induced neutropenia has also been reported in a few clinical cases. Despite β-lactam antibiotics being superior to non-β-lactam antibiotics in certain situations, such as for treating methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia [ 3 ], few studies have examined the use of alternative β-lactam antibiotics for the treatment of ceftriaxone-induced neutropenia [ 4 , 5 , 6 ]. We describe a case of a male patient who developed neutropenia while receiving high doses of ceftriaxone (4 g/day) for infective endocarditis with central nervous complications, which resolved after the cessation of the medication; his neutropenia did not relapse after the medication was replaced with ampicillin sodium.…”

Section: Introductionmentioning

confidence: 99%

Ceftriaxone-Induced Neutropenia Successfully Treated With Alternative β-Lactam Antibiotics: A Case Report and Review of the Literature

Satake¹,

Iijima²

2023

Cureus

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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.

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“…In most case reports, it has occurred in a patient on ceftriaxone 2 g IV daily for >21 days. 6,7 The cumulative dose potentially leads to an immune-mediated mechanism that induces antibody formation against neutrophils in a dose-dependent inhibition of granulopoiesis. 8 Vancomycin-induced neutropenia typically occurs with prolonged exposure of at least 7 days, usually after 20 days of therapy, and resolves within 48 to 72 hours of vancomycin withdrawal.…”

Section: Case Summarymentioning

confidence: 99%

Section: Case Summarymentioning

confidence: 99%

Vancomycin-Induced Leukopenia and Neutropenia: Time Will Tell

Nguyen

Ayyad

2023

Hosp Pharm

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Purpose: Neutropenia is an uncommon adverse effect associated with prolonged vancomycin therapy. Methods: This was a case report on a 62-year-old African American male with hypertension, paranoid schizophrenia, and a history of polysubstance abuse developed foot osteomyelitis. The patient was initially maintained on intravenous Vancomycin & Ceftriaxone for ~3 weeks but adjusted to Daptomycin & Ceftriaxone while in hospital due to neutropenia. Patient’s neutropenia quickly resolved once discontinuation of Vancomycin occurred. Results: Vancomycin is a potential cause of drug induced leukopenia and neutropenia. Monitoring of leukocytes and neutrophils is warranted in patients receiving long term intravenous Vancomycin therapy. Conclusion: Vancomycin is a bactericidal glycopeptide antibiotic with activity against gram-positive organisms such as Staphylococci. Well-known adverse drug events include nephrotoxicity and ototoxicity. Vancomycin-induced neutropenia on the other hand is less common and reported at lower rates. It is defined as an ANC less than 1000 µL in patients maintained on Vancomycin infusions. According to Black et al, neutropenia is more likely associated with prolonged therapy; generally occurring at least 20 days after initiation.

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Ceftriaxone-induced Agranulocytosis

Cited by 4 publications

References 6 publications

Agranulocytosis Associated With Use of Sulfamethoxazole/Trimethoprim in a Healthy Adult

Agranulocytosis Associated With Use of Sulfamethoxazole/Trimethoprim in a Healthy Adult

Ceftriaxone-Induced Neutropenia Successfully Treated With Alternative β-Lactam Antibiotics: A Case Report and Review of the Literature

Vancomycin-Induced Leukopenia and Neutropenia: Time Will Tell

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