Penicillin-induced granulopenia.

Forshaw, J.

doi:10.1136/bmj.3.5611.184

Cited by 12 publications

(8 citation statements)

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“…Leukoagglutinins have been demonstrated in penicillin-induced granu locytopenia [8]. However, in the 8 reported cases of granulocytopenia secondary to semisynthetic penicillins, leukoagglutinins were not present (table 1).…”

Section: Drugmentioning

confidence: 71%

“…Although sought for, leukoagglutinins could not be demonstrated in either patient. The occurrence of granulocytopenia in patients re ceiving natural and semisynthetic penicillins is reviewed and the mechanisms are outlined.Granulocytopenia following use of penicillin and its analogues has been reported infrequently [1][2][3][4][5][6][7][8]. Our hospital recently began using oxa cillin and within the first 4 months two cases of oxacillin-induced granu locytopenia were observed.…”

mentioning

confidence: 99%

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Oxacillin-Induced Granulocytopenia

Fallon¹,

Tall²,

Janis³

et al. 1978

Acta Haematol

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The development of granulocytopenia during oxacillin therapy is reported in 2 patients. In both cases the onset of granulocytopenia occurred 24 days after therapy was instituted with similar clinical presentations. The bone marrow aspirates revealed myeloid hyperplasia, left shift and maturation arrest. 24 h after oxacillin was discontinued the granulocyte counts rapidly rose towards normal, with subsequent complete recovery. Although sought for, leukoagglutinins could not be demonstrated in either patient. The occurrence of granulocytopenia in patients receiving natural and semisynthetic penicillins is reviewed and the mechanisms are outlined.

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Section: Drugmentioning

confidence: 71%

mentioning

confidence: 99%

Oxacillin-Induced Granulocytopenia

Fallon¹,

Tall²,

Janis³

et al. 1978

Acta Haematol

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“…Cumulative β-lactam dose appears to be an important factor, suggesting that the reaction may be triggered by accumulation of toxic metabolites. 3,4,[10][11][12][13][14][15][16][17][18][19][20] Primary management of β-lactam-induced neutropenia involves discontinuation of the offending agent. To expedite Annals of Pharmacotherapy 55 (8) resolution of neutropenia, the use of granulocyte-colony stimulating factor (G-CSF) has been advocated, particularly for those with poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

A Review of β-Lactam–Associated Neutropenia and Implications for Cross-reactivity

2020

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Objective: To review the incidence, management, and current understanding of the pathophysiology of β-lactam–induced neutropenia and to critically evaluate the practicality and safety of direct substitution to an alternative β-lactam in the setting of this reaction. Data Sources: A literature analysis using the PubMed and Ovid search engines (July 1968 to October 2020) was performed using the search terms neutropenia, leukopenia, β-lactam, nonchemotherapy, agranulocytosis, and G-CSF (granulocyte colony-stimulating factor). Study Selection and Data Extraction: The included English-language studies evaluated the incidence, mechanism, and/or management of β-lactam–induced neutropenia in pediatric or adult patients. Data Synthesis: Drug-induced neutropenia is a well-documented adverse reaction of β-lactam antibiotics, with an incidence of approximately 10% following at least 2 weeks of intravenous therapy. However, multiple gaps in knowledge remain in the mechanism of pathophysiology and optimal management of this reaction. Both direct toxic and immune-mediated mechanisms have been implicated. Although the cornerstone of management includes cessation of the offending agent, controversy exists on the appropriateness of direct substitution or future use of an alternative β-lactam. Relevance to Patient Care and Clinical Practice: Given the frequency of use and superiority of β-lactams over alternative therapy for several infectious disease states, practical recommendations are needed on the management and safe use of β-lactams following β-lactam–induced neutropenia. Conclusion: Future use of β-lactams with differing R1 side chains, particularly those from a separate class, should not be deemed contraindicated following β-lactam–induced neutropenia and may be considered when indicated, with close laboratory monitoring.

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“…For example, Hieber and Nelson studied patients receiving penicillin intermittently and reported that during the acute phase of meningitis, the concentrations of penicillin in CSF averaged 18.4% of the levels in serum (12 (28). Granulocytopenia has been reported with most other penicillins (6,10,16,20). This reaction appears to be related to the dose and duration of the administration of penicillin (20).…”

Section: Methodsmentioning

confidence: 99%

Clinical evaluation of piperacillin with observations on penetrability into cerebrospinal fluid

Dickinson¹,

Droller²,

Greenman³

et al. 1981

Antimicrob Agents Chemother

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Piperacillin, a new semisynthetic penicillin, was evaluated for efficacy and safety in 26 patients, most of whom had pneumonia. Included were four patients with gram-negative meningitis in whom the penetration of piperacillin into cerebrospinal fluid was determined. Cure was achieved in 11 of 17 patients with pneumonia; another 4 were improved. One relapse and one failure occurred among nine patients with gram-negative pneumonia. Cure or improvement occurred in seven of nine patients with gram-negative infection in various extrapulmonary sites. Piperacillin given by continuous infusion in a dosage ranging from 324 to 436 mg/kg of body weight per day to four patients with meningitis resulted in a mean cerebrospinal fluid level of 23 tig/ml at 24 h; the mean penetration of piperacillin into the cerebrospinal fluid was 32% at this interval. Levels of piperacillin in cerebrospinal fluid collected later during the course of therapy were also adequate. Adverse effects were noted in six patients, but only one episode of granulocytopenia was serious. Emergence of resistance to piperacillin did not occur, and only one superinfection was noted. Piperacillin appeared to be efficacious in the treatment of pneumonia. It penetrated well into the cerebrospinal fluid of patients with meningitis and may be useful for treatment of selected gram-negative infections in extrapulmonary sites.Piperacillin is a new semisynthetic antibiotic formed by the attachment of a piperazine derivative to aminobenzylpenicillin. This agent has a broad spectrum of activity that includes Pseudomonas aeruginosa and many species of Enterobacteriaceae. Most P. aeruginosa isolates are inhibited at concentrations of piperacillin that are considerably lower than those of carbenicillin or ticarcillin (4,8,11,27). The antibacterial spectrum of piperacillin is greater than that of other penicillins now available and includes Klebsiella pneumoniae, a species usually resistant to the other penicillin derivatives (17,26,29). Piperacillin is not active against penicillinase-producing staphylococci or certain isolates of gram-negative bacilli that have acquired resistance to the other ,B-lactam antibiotics, since it is inactivated by some 8-lactamases (26). Piperacillin can be given in sufficient quantities to achieve levels in the serum well above the concentrations needed to inhibit many bacteria that commonly cause serious infections (1).

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Penicillin-induced granulopenia.

Cited by 12 publications

References 1 publication

Oxacillin-Induced Granulocytopenia

Oxacillin-Induced Granulocytopenia

A Review of β-Lactam–Associated Neutropenia and Implications for Cross-reactivity

Clinical evaluation of piperacillin with observations on penetrability into cerebrospinal fluid

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