Antibiotics And Leukopenia

1. Antibiotics and Neutropenia

2. Definite
• 1.Neutropenia
:

ANC(absolute neutrophil

count )<
500-1000/mm
3
•2.ANC<1000/mm
3 :
susceptibility to
infectious diseases increases .
•3.ANC<500 /mm
3
:
noraml microbial flora pathogen

3. Causes of Neutropenia
•Decreased Production
•Peripheral Destruction
•Peripheral Pool

4. Decreased Production
•Drug-induced-alkylating agents
•Hematologic diseases
•Tumor invasion
•Nutritional deficiency-vitamin B12, folate
(especially alcoholics)
•Infection

5. Periperal Destruction
•Antineutrophil antibodies and/or splenic or
lung (alveolar macrophage) trapping
•Autoimmune disorders-
•Drugs as haptens-
•Wegener's granulomatosis

6. Peripheral Pool
•Overwhelming bacterial infection (acute
endotoxemia)
•Hemodialysis
•Cardiopulmonary bypass

7. Common Antibiotics
•1.Penicillin
•2.Cephem
•3.Monobactam
•4.Carbapenem
•5.Aminoglycoside
•6.Fluoroquinolone
•7.Macrolide
•8.Glycopeptide
•9.sulfa drug
•10.others

8. Penicillin 類抗生素
•1.PENICILLIN
•2.AMOXICILLIN/CLAVULANIC ACID
(Augmentin)
•3.TICARCILLIN/CLAVULANIC ACID
(Timentin)
•4.PIOERACILLIN/TAZOBACTAM
(Tazocin)-6%

9. 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

10. 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

11. 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

12. 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

13. Cephem類抗生素
•1. Cephalexin
•2.Cefoxitin
•3.Ceftriaxone,Cefoperazone
•4.Cefepime

14. 1.Keflex ® induced neutropenia
•1.Incidence : 3 %
•2.Suggest : allergic reactions, occurring in
0.9 to 3.2% of patients.

15. 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
days, 32% and 18% developed eosinophilia and
neutropenia

16. 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

17. 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

18. 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

19. CARBAPENEM類抗生素
•1.Imipenem(Tienam®)
•2.Meropenem(Mepem®)

20. Tienam ® induced neutropenia
•1.Incidence :
Leukopenia ,granulocytopenia in 1% of
patients in therapeutic doses
•2.Onset : 12.5 days.
•3.Recover : drug withdrawal

21. 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

22. 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
treatment of meningitis in children

23. 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

24. Glycopeptide類抗生素
•1.Vancomycin(Vancocin ®)
•2.Teicoplanin( Targocid ®)

25. 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.

26. Vancocin ® induced neutropenia
•4.Suggest :
a.reversible by administration of
granulocyte colony-stimulating factor
b.long- term use should monitor leukocyte
counts

27. 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

28. 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
hematologic toxicities caused by cotrimoxazole
use in patients with AIDS

29. Anegyn ® induced neutropenia
•1.Incidence : 1% leukopenia
•2.Onset : unknown
•3.Recover : reversible after drug withdrawal

•4.Suggest : used carefully

30. 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