Coagulopathy associated with extended-spectrum cephalosporins in patients with serious infections

Abstract

Patients enrolled in two double-blind multicenter studies were evaluated for the development of hypoprothrombinemia during treatment with cephalosporins. Patients with pneumonia or peritonitis received ceftizoxime, cefotaxime, or moxalactam. The incidence of hypoprothrombinemia was greater in patients with peritonitis (12 of 49) than in those with pneumonia (5 of 96; P < 0.05). Overall, moxalactam was associated with a higher incidence of hypoprothrombinemia (13 of 52) than either ceftizoxime (1 of 43; P < 0.05) or cefotaxime (3 of 50; P < 0.05), and moxalactam patients incurred the highest average increase in prothrombin time (3.7 s) as compared with either ceftizoxime (0.5 s; P < 0.05) or cefotaxime (0.9 s; P < 0.05) patients. The occurrence of hypoprothrombinemia in moxalactam patients with peritonitis was not related to dosage, duration of therapy, age, sex, race, or renal or hepatic function. The degree of ileus was, however, strongly related to the development of coagulopathy in moxalactam-treated patients only.

Antimicrobial Therapy for the Elderly Patient

“…Other cephalosporins have minimal risk in causing renal damage. Prolongation of prothrombin time and partial thromboplastin time may occur with cefamandole, cefotetan, cefoperazone, and moxalactam due to their methylthiotetrazole side chain 80 , 122 ; these abnormalities are correctible with parenteral vitamin K administration. However, moxalactam has been often implicated in clinically important bleeding, which is most likely caused by its added effect on platelet function 123 .…”

Prospective Alterations in Therapy for Penetrating Abdominal Trauma

“…(11) 20 (43) 28 (23) 13 (52) 7 (29) 23 (27) 5 (14) 36 (39) 12 (16) 4 (27) 44 (28) 34 (38) 14 (18) 44 (30) 4 (24) 22 (45) 26 (22) 25 (46) 10 (20) 13 (20) 13 (38) 29 (33) 6(12) 43 (30) 4(20) 1 (17) 6 (40) 22 (32) 15 (25) 5 (18) major and 2% minor infection rates, not significantly dif¬ ferent from the previous study.…”

A suspicious case of cefmetazole‐induced hypoprothrombinemia

“…The average time of nine cases, except two not described in detail, from initiation of antibiotic therapy to diagnosing hypoprothrombinemia or bleeding was 8.1 days (range, 2‐20 days). In contrast, the average time was reported to be 5.7 days (range, 2‐15 days) when the cephalosporins were used in 17 cases . Eight of the nine cases were recognized as hypoprothrombinemia with bleeding; almost all cases survived after being administered vitamin K supplements.…”

“…In contrast, the average time was reported to be 5.7 days (range, 2-15 days) when the cephalosporins were used in 17 cases. 4 Eight of the nine cases were recognized as hypoprothrombinemia with bleeding; almost all cases survived after being administered vitamin K supplements. Furthermore, hypoprothrombinemia is preventable by vitamin K prophylaxis if administered once or three times weekly.…”