Latamoxef‐induced coagulation disorders: Incidence and risk factors

Abstract

Latamoxef is a broad-spectrum oxacephem antibiotic widely used in moderate to severe infections such as respiratory, intra-abdominal or urinary tract infections. Latamoxef has an N-methylthiotetrazole (NMTT) side chain which was thought to be a key structure to induce vitamin K deficiency, hypoprothrombinemia, thrombocytopenia and bleeding. 1 Cefoperazone, which also carries an NMTT structure, was linked with a higher risk of hypoprothrombinemia, with the reported incidence ranging 4%-68%. 2 Several researchers noticed that latamoxef could induce prolonged prothrombin time (PT) or activated partial thromboplastin time (APTT). 1,3 However, there were very few Asian patients till now. Zhu et al reported two cases of severe coagulation disorder induced by latamoxef. 4 In this study, we initiated a retrospective cohort study and included 162 Chinese patients with different conditions, thus to give insight into the effects of latamoxef on coagulation function. | ME THODS | Patient selectionA retrospective cohort study was conducted and patients treated with ceftazidime or latamoxef at Second Affiliated Hospital of Xi'an Jiaotong University between 1 January 2018 and 31 December 2018 were included. Exclusion criteria included: Patients were experiencing episodes of haematemesis; patients with sepsis, liver

Latamoxef dosing regimen adjustments and pharmaceutical care in pediatrics

“…The bleeding risk is thought to be related to the administration of latamoxef. Patients who are seriously ill, debilitated, or malnourished, or with renal impairment, are more likely to develop the condition ( 30 , 31 ). Abnormalities of liver function manifest as hepatic enzyme abnormalities, such as increased serum glutamic oxaloacetic or pyruvic transaminases or alkaline phosphatase ( 29 ).…”

“…Malnutrition is a risk factor for coagulation disorders ( 1 , 30 , 36 ). This is because malnutrition may result in decreased vitamin K intake, decreased gastrointestinal absorption of vitamin K, and antibiotic inhibition of the gastrointestinal flora that synthesizes vitamin K, all of which lead to vitamin K-dependent coagulation and hemoglobin reduction ( 36 ).…”

“…Subgroup analyses revealed a significant association between latamoxef and hypoprothrombinemia (34). As a third-generation cephalosporin, latamoxef contains an N-methylthiotetrazole (NMTT) side chain, which can interfere with vitamin K metabolism and therefore induce coagulation disorders and bleeding risks (30). In addition, latamoxef can also inhibit adenosine diphosphate (ADP)-induced platelet aggregation by perturbing the platelet membrane, making ADP receptors unavailable to the agonist, thus causing coagulation disorders (35).…”

Development and validation of a nomogram for predicting cefoperazone/sulbactam-induced hypoprothrombinaemia in Hospitalized adult patients

“…There is currently a lack of accurate incidence data on cefoperazone/sulbactam-induced hypoprothrombinaemia among all hospitalized patients. In the previous literature, the incidence of cefoperazone/sulbactam-induced hypoprothrombinaemia in hospitalized patients ranged from 4% to 68% depending on the definition of this adverse event and the study population [ 6 ]. Clinical manifestations include haematuria and subcutaneous, gastrointestinal and cerebral bleeding, which are associated with increased treatment difficulty and longer hospital stay [ 7 , 8 ], and can sometimes be fatal [ 9 ].…”