β-lactam-associated neutropenia
From IDWiki
Background
- Adverse reaction to β-lactam antibiotics occurring in about 10% of courses longer than 2 weeks
- Higher risk with penicillin G, nafcillin, oxacillin, piperacillin-tazobactam, ceftriaxone, and ceftaroline
- Risk increases with cumulative exposure
- Mechanism is unclear; may be some combination of a direct toxic effect or an immune-mediated hypersensitivity reaction
Clinical Manifestations
- Neutropenia
- Usually presents after 2 to 3 weeks of parenteral antibiotics
- Rash in 25-50% of cases
- May have associated eosinophilia or thrombocytopenia
- Can progress to agranulocytosis
Management
- Consider stopping the offending antibiotic if ANC falls below 1
- Other β-lactam antibiotics are probably still safe to use
Further Reading
- A Review of β-Lactam-Associated Neutropenia and Implications for Cross-reactivity. Ann Pharmacother. 2021;55(8):1037-1049. doi: 10.1177/1060028020975646
