Thrombocytopenia Possibly Caused by Structurally Related Third-Generation Cephalosporins

Abstract

Thrombocytopenia is defined as a decrease in the platelet count to less than 100 x 10(9)/L and it is the most commonly reported drug-induced blood dyscrasia. Heparin is the most commonly reported cause of drug-induced thrombocytopenia with a reported incidence between one and ten percent. Thrombocytopenia induced by cephalosporins has been reported but is relatively rare. This report does not completely document that two third-generation cephalosporins caused platelet counts to fall less than 100 x 10(9)/L in the patient described but there was no other explanation available. Platelet counts began to fall with the institution of third-generation cephalosporins and began to rise when these agents were stopped. In order to document that thrombocytopenia was induced by the third-generation cephalosporins a rechallenge would have been necessary; this was not considered to be safe in this patient. A review of the literature is presented describing similar cases of cephalosporin-induced thrombocytopenia.

Ceftriaxone causes drug‐induced immune thrombocytopenia and hemolytic anemia: characterization of targets on platelets and red blood cells

“…18 Cephalosporin DITP is less frequent but has also been observed with second-generation 29,30 and with third-generation cephalosporins. 23 In the latter report, ceftriaxone was discussed as a possible cause of thrombocytopenia together with cefuroxime and ceftazidime, but no antibody was demonstrated. 23 We report in this study on the first two patients with DITP and another patient with DIHA, both induced by ceftriaxone, and the characterization of the targets of the corresponding DDAbs.…”

“…23 In the latter report, ceftriaxone was discussed as a possible cause of thrombocytopenia together with cefuroxime and ceftazidime, but no antibody was demonstrated. 23 We report in this study on the first two patients with DITP and another patient with DIHA, both induced by ceftriaxone, and the characterization of the targets of the corresponding DDAbs. Both DITP patients presented the typical clinical picture of hemorrhagic diathesis and severe thrombocytopenia after 1 to 2 weeks of drug administration and an immediate increase of the PLT count after discontinuation of ceftriaxone.…”

“…Most frequently, the second‐generation cephalosporin cefotetan and the third‐generation cephalosporin ceftriaxone are involved 18 . Cephalosporin DITP is less frequent but has also been observed with second‐generation 29,30 and with third‐generation cephalosporins 23 . In the latter report, ceftriaxone was discussed as a possible cause of thrombocytopenia together with cefuroxime and ceftazidime, but no antibody was demonstrated 23 .…”

“…21,22 Interestingly, DITP due to ceftriaxone has so far only been suspected but not proven. 23 We describe the first two patients with ceftriaxoneinduced DITP. The responsible DDAbs reacted with epitopes residing on GPIIb/IIIa and on GPIX.…”

Serologically documented loracarbef (Lorabid)‐induced immune thrombocytopenia

“…Although loracarbef-induced thrombocytopenia has not previously been reported, this side effect has been described in patients treated with other cephalosporins. The implicated drugs include first-generation [13,14], second-generation [15,16], and third-generation [17,18] cephalosporin compounds. In the reported cases, thrombocytopenia generally occurred after 3-10 days of treatment, was usually severe (platelet counts less than 10,000/L), and was associated with significant bleeding symptoms.…”