Antibiotics And Leukopenia

Antibiotics and Neutropenia

Definite

• 1.Neutropenia :

ANC(absolute neutrophil count )< 500-1000/mm3

• 2.ANC<1000/mm3 : susceptibility to infectious diseases increases .

• 3.ANC<500 /mm3 :

noraml microbial flora pathogen

Causes of Neutropenia

• Decreased Production

• Peripheral Destruction

• Peripheral Pool

Decreased Production

• Drug-induced-alkylating agents

• Hematologic diseases

• Tumor invasion

• Nutritional deficiency-vitamin B12, folate (especially alcoholics)

• Infection

Periperal Destruction

• Antineutrophil antibodies and/or splenic or lung (alveolar macrophage) trapping

• Autoimmune disorders-

• Drugs as haptens-

• Wegener's granulomatosis

Peripheral Pool

• Overwhelming bacterial infection (acute endotoxemia)

• Hemodialysis

• Cardiopulmonary bypass

Common Antibiotics

• 1.Penicillin

• 2.Cephem

• 3.Monobactam

• 4.Carbapenem• 5.Aminoglycoside

• 6.Fluoroquinolone

• 7.Macrolide

• 8.Glycopeptide

• 9.sulfa drug

• 10.others

Penicillin 類抗生素

• 1.PENICILLIN • 2.AMOXICILLIN/CLAVULANIC ACID

(Augmentin)• 3.TICARCILLIN/CLAVULANIC ACID (Time

ntin) • 4.PIOERACILLIN/TAZOBACTAM (Tazoci

n)-6%

1.Penicillin G induced neutropenia

• 1.Incidence : rare

• 2.Onset : 20 million units daily for 2 week

• 3.Recover : within 3 days

• 4.Suggest : intensive monitoring of patients with SBE receiving high dose penicillin therapy

2.Augmentin ® induced neutropenia


• 2.Onset :1.5 g Augmentin daily for 45 days


• 4.Suggest : WBC monitor

3.Timentin® induced neutropenia


• 2.Onset : 9 days of treatment with 3.1 gram every 6 hours for pneumonia.


• 4.Suggest : monitor of WBC

4.Tazocin® induced neutropenia

• 1.Incidence : 6 %

• 2.Onset : 200 to 300 mg/kg piperacillin developed neutropenia 15-23 days

• 3.Recover : 3-8 days

• 4.Suggest : be careful used in child

Cephem類抗生素

• 1. Cephalexin

• 2.Cefoxitin

• 3.Ceftriaxone,Cefoperazone

• 4.Cefepime

1.Keflex ® induced neutropenia

• 1.Incidence : 3 %

• 2.Suggest : allergic reactions, occurring in 0.9 to 3.2% of patients.

2.Zinacef ® induced neutropenia

• 1.Incidence : 1/10 decreases in hematocrit and hemoglobin 1/750 leukopenia 1/100 transient neutropenia• 2.Onset : 5 days • 3.Recover when therapy is discontinued • 4.Suggest : In children treated for more than 5 day

s, 32% and 18% developed eosinophilia and neutropenia

3. Rocephin ® induced neutropenia

• 1.Incidence :

2% , CEFTRIAXONE(ROCEPHIN ®)

1.1% ,CEFTAZIDIME(FORTUNE ®)

• 2.Onset : 21days of treatment with high dose

• 3.Recover : slowly resolved


4. Maxipime® induced neutropenia

• 1.Incidence :

1 %

• 2.Onset : 30 days of therapy with cefepime 2 grams intravenously every 12 hours.

• 3.Recover : 4-7 days


Azactam ® induced neutropenia

• 1.Incidence :

less than 1% of patients • 2.Onset : unknown• 3.Recover : unknown • 4.Suggest : PANCYTOPENIA, NEUTROPENIA,

THROMBOCYTOPENIA, ANEMIA, LEUKOCYTOSIS, and THROMBOCYTOSIS

CARBAPENEM類抗生素

• 1.Imipenem(Tienam®)

• 2.Meropenem(Mepem®)

Tienam ® induced neutropenia

• 1.Incidence :

Leukopenia ,granulocytopenia in 1% of patients in therapeutic doses

• 2.Onset : 12.5 days.

• 3.Recover : drug withdrawal

Tienam ® induced neutropenia

• 4.Suggest : G-CSF therapy may be beneficial in the management of drug-induced agranulocytosis in elderly patients.

• American Journal of Medicine. Vol 112(6) (pp 460-464), 2002

Mepem ® induced neutropenia

• 1.Incidence : case report NEUTROPENIA, THROMBOCYTOPENIA, and ANEMIA

• 2.Onset : meropenem 40 mg/kg every 8 hours for 2 weeks followed by 100 mg/kg every 8 hours for 2 weeks ,

to treat a Morganella morgani meningitis • 3.Recover : 2 weeks • 4.Suggest : recommended dose of 40 mg/kg for treat

ment of meningitis in children

U-Gencin ® induced neutropenia


• 2.Onset : 80 mg daily IM over a period of 1 week for S.aureus

• 3.Recover : 1 month

• 4.Suggest : WBC monitor

Glycopeptide類抗生素

• 1.Vancomycin(Vancocin ®)

• 2.Teicoplanin( Targocid ®)

Vancocin ® induced neutropenia

• 1.Incidence : 2 % of Neutropenia, thrombocytopenia, and agranulocytosis

• 2.Onset : (17-35 days)

starts 1 week more after therapy

after a total dosage of > 25 g

• 3.Recover : after discontinuation of therapy.

Vancocin ® induced neutropenia

• 4.Suggest :

a.reversible by administration of granulocyte colony-stimulating factor

b.long- term use should monitor leukocyte counts

Targocid ® induced neutropenia

• 1.Incidence : teicoplanin-induced leukopenia is low (0.33%)

• 2.Onset : (7-21) days, initial dose of 400 mg followed by 200 mg every 24 hours.

• 3.Recover : reversible after drug withdrawal


Baktar ® induced neutropenia

• 1.Incidence : P’s with AIDS would increase the incidence of leukopenia (0.33%)

• 2.Onset : 9 days of TMP 20 mg/kg/day & SMX 100 mg/kg/day for PCP infection in AIDS • 3.Recover : reversible after drug withdrawal • 4.Suggest : leucovorin ® for preventing hematolo

gic toxicities caused by cotrimoxazole use in patients with AIDS

Anegyn ® induced neutropenia

• 1.Incidence : 1% leukopenia

• 2.Onset : unknown

• 3.Recover : reversible after drug withdrawal

• 4.Suggest : used carefully

Take home massages

• 1.Most antibiotics induced neutropenia

• 2.Careful use and WBC moniotr

• 3.Drug withdrawal is first choice

• 4.Don’t forget find other reason of neutropenia

Antibiotics And Leukopenia

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