Î’-lactam-associated neutropenia: Difference between revisions
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Î’-lactam-associated neutropenia
(Created page with "{{DISPLAYTITLE:β-lactam-associated neutropenia}} == Background == * Adverse reaction to β-lactam antibiotics occurring in about 1 to 10% of prolonged courses * 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 Hypersensitivity reaction|immune-mediated...")  |
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== Background == |
== Background == |
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| − | * Adverse reaction to [[Β-lactams|β-lactam antibiotics]] occurring in about |
+ | * Adverse reaction to [[Β-lactams|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]] |
* Higher risk with [[penicillin G]], [[nafcillin]], [[oxacillin]], [[piperacillin-tazobactam]], [[ceftriaxone]], and [[ceftaroline]] |
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* Risk increases with cumulative exposure |
* Risk increases with cumulative exposure |
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* [[Neutropenia]] |
* [[Neutropenia]] |
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| + | * Usually presents after 2 to 3 weeks of parenteral antibiotics |
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| + | * Rash in 25-50% of cases |
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| + | * May have associated [[eosinophilia]] or [[thrombocytopenia]] |
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* Can progress to [[agranulocytosis]] |
* Can progress to [[agranulocytosis]] |
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== Management == |
== Management == |
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| − | * |
+ | * Consider stopping the offending antibiotic if ANC falls below 1 |
* Other β-lactam antibiotics are probably still safe to use |
* Other β-lactam antibiotics are probably still safe to use |
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Latest revision as of 23:20, 23 July 2022
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
