Oxacillin-induced neutropenia in children

Leventhal, John M.; Silken, Alan B.

doi:10.1016/s0022-3476(76)80800-1

Cited by 20 publications

(8 citation statements)

References 7 publications

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“…• If exact values were lacking, these symptoms were considered present when they were at least stated qualitatively. Exposure to the same or a different fJ-Iactam antibiotic induced a relapse in only 12 (31070) of the 39 patients rechallenged (including our cases) [6,7,II,13,26,27,29,30,32,36,[40][41][42]46,49,52,59,63,67,69,85J. The induction of a relapse depended clearly on the duration and dosage of therapy with (3-lactam antibiotic, as did the first induction of neutropenia.…”

Section: Discussionmentioning

confidence: 72%

Inhibition of Granulopoiesis in Vivo and in Vitro by -Lactam Antibiotics

Neftel

Hauser

Müller

1985

Journal of Infectious Diseases

187

129

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beta-Lactam antibiotics can induce severe neutropenia by a hitherto unknown mechanism. Fifty cases of beta-lactam antibiotic-induced neutropenia (less than 1,000 neutrophils/mm3) from 17 hospitals were analyzed and compared with 140 literature cases. The incidence of neutropenia was 5%-greater than 15% in patients treated for greater than or equal to 10 days with large doses of any beta-lactam antibiotic but less than 0.1% with shorter duration of therapy. In greater than 95% of cases recovery occurred between one to seven days after withdrawal of beta-lactam antibiotics. Bone marrow aspirates were characterized by a lack of well-differentiated myeloid elements in the presence of numerous immature granulocyte precursors. Nine penicillins and eight cephalosporins inhibited in vitro granulopoiesis in a dose-dependent manner. There was a good correlation between the inhibitory capacity of beta-lactam antibiotics in vitro and the doses inducing neutropenia in vivo. These observations may be relevant for therapy in the granulocytopenic patient.

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Section: Discussionmentioning

confidence: 72%

Inhibition of Granulopoiesis in Vivo and in Vitro by -Lactam Antibiotics

Neftel

Hauser

Müller

1985

Journal of Infectious Diseases

187

129

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“…Methicillin and ticarcillin have been reported to cause a transient, dose dependent neutropenia in adult population [11]. There have been only rare reports of neutropenia secondary to ampicillin [12], nafcillin [13], oxacillin [14], and methacillin [15] in the pediatric age group. We have added cloxacillin to the list of semisynthetic penicillins that may cause neutropenia in children.…”

Section: Discussionmentioning

confidence: 99%

Neutropenia Associated with Cloxacillin and Other Semisynthetic Penicillins in Children

Al-Fadley

1992

Ann Saudi Med

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Five children treated with high dose of semisynthetic penicillin for three to four weeks developed neutropenia (< 1.5 × 10 9 /L). All patients were on cloxaxillin. In addition, three patients received ampicillin, and one received piperacillin therapy for the same duration. All patients developed neutropenia 15 to 23 days following therapy and resolved 8 to 95 days after discontinuation of the penicillin. One patient developed serious perianal necrotizing fascitis as a complication of neutropenia. The red blood cell count and platelets were normal in all patients. Bone marrow aspiration performed on two patients revealed a maturation arrest of the granulocyte precursor. A complete cell count and differential should be monitored during high dose penicillin therapy. Neutropenia in adults is a rare but well recognized complication of high dose therapy with penicillin and its semisynthetic derivatives (nafcillin, oxacillin, cloxacillin, ampicillin, carbenicillin, piperacillin, methicillin and ticarcillin [1][2][3][4][5][6][7][8][9].Not all the penicillins noted have been reported to cause neutropenia in children. There has been only one report of cloxacillin induced neutropenia in the pediatric age group [10]. Furthermore, this paper emphasizes the possible additive effects of more than one penicillin. Patients and MethodsCloxacillin alone or administered in conjunction with other semisynthetic penicillins, was implicated as the cause of neutropenia in five children seen at King Saud University and the Security Forces Hospital in Riyadh, Saudi Arabia over a nine-month period.All patients received a prolonged (mean 28 days) high dosage (45 to 126 gm/m 2 ) of cloxacillin alone or in conjunction with other semisynthetic penicillins. At the time of diagnosis complete blood count (CBC) and differential was obtained and weekly thereafter. At,the onset of neutropenia a CBC was obtained twice weekly until complete recovery was documented. All patients were followed up (mean follow-up time six months) and in none of the patients did neutropenia recur. Other causes of neutropenia were excluded and neutrophil anti-bodies were negative in cases I, II, III and IV.With the exception of case III, who was on aspirin prior to and throughout the course of illness, none of the patients were on any other medications. No patients were rechallenged with the offending medication. Case 1A two-year-old Saudi girl was admitted with a ten day history of fever and limp. Bone aspirate and pus obtained from a surgical drainage confirmed the clinical diagnosis of staphylococcal osteomyelitis. On admission, the white blood cell count (WBC) was 19.8 ×

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“…Other beta-lactam agents such as ticarcillin and oxacillin have also been associated with this phenomenon [7,15]. Other toxicides associated with latam oxef include hypoprothrombinemia, disulfuram-like reactions, and colonization or superinfection with latamoxef-resistant organisms, notably entercoccus and pseu domonas [17], As a single agent, latamoxef provides appropriate antimicrobial coverage against the bacterial pathogens typically associated with childhood skeletal infec tions.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Latamoxef as Initial Therapy of Bone and Joint Infections in Childhood

Aronoff¹,

Scoles²,

Reed³

et al. 1984

Chemotherapy

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The efficacy and pharmacokinetics of latamoxef were evaluated during initial therapy of bacteriologically proven bone and joint infections in children. Pharmacokinetic evaluation revealed no significant difference in latamoxef biodisposition after the first dose or at steady state. Peak serum concentrations exceeded 140 mg/l and 8-hour trough concentrations averaged 6.5 mg/l. The patients were infected with a variety of gram-positive and gram-negative pathogens. All were sensitive to readily achievable serum concentrations of latamoxef; moreover, the serum concentration remained above the MIC of the most resistant organism for at least 7 h after each dose. All patients responded favorably to initial therapy and there have been no relapses in more than 2 years of clinical follow-up.

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Oxacillin-induced neutropenia in children

Cited by 20 publications

References 7 publications

Inhibition of Granulopoiesis in Vivo and in Vitro by -Lactam Antibiotics

Inhibition of Granulopoiesis in Vivo and in Vitro by -Lactam Antibiotics

Neutropenia Associated with Cloxacillin and Other Semisynthetic Penicillins in Children

Evaluation of Latamoxef as Initial Therapy of Bone and Joint Infections in Childhood

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