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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
• 1.Incidence : rare
• 2.Onset :1.5 g Augmentin daily for 45 days
• 3.Recover : within 6 days
• 4.Suggest : WBC monitor
3.Timentin® induced neutropenia
• 1.Incidence : rare
• 2.Onset : 9 days of treatment with 3.1 gram every 6 hours for pneumonia.
• 3.Recover : within 4 days
• 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.Suggest : monitor of WBC
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
• 4.Suggest : monitor of WBC
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
• 1.Incidence : rare
• 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
• 4.Suggest : monitor of WBC
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