Yam Felix K, Kwan Brian K
Felix K. Yam, Pharm.D., M.A.S., BCPS, is Assistant Clinical Professor of Pharmacy, University of California (UC) San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla. Brian K. Kwan, M.D., is Assistant Clinical Professor of Medicine, UC San Diego School of Medicine, La Jolla.
Am J Health Syst Pharm. 2014 Sep 1;71(17):1457-61. doi: 10.2146/ajhp130474.
A case of profound neutropenia and agranulocytosis associated with the off-label use of ceftaroline is reported.
A 67-year-old Caucasian man arrived at the emergency room with right shoulder pain and weakness that radiated to his right chest, back, and right arm. A review of symptoms was notable for two days of burning with urination associated with decreased urinary output and decreased appetite. Multiple tests revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis, which was treated with an off-label dosage of ceftaroline (600 mg intravenously every eight hours). At the start of ceftaroline therapy, the patient's baseline absolute neutrophil count (ANC) was 6640 cells/μL and decreased to 816 cells/μL by day 19, eventually falling to 0 cells/μL on day 21 of therapy. Ceftaroline was then discontinued due to the suspicion that the neutropenia was secondary to maturation arrest of the bone marrow. The patient was switched to i.v. daptomycin to finish a six-week course of antibiotics. Interventional radiology placed a drain in the patient's right shoulder during the hospital stay, with symptom improvement. His white blood cell count continued to increase after ceftaroline discontinuation, reaching 6.5×10(3) cells/μL with a differential of 56.6% segmented neutrophils and 28.4% lymphocytes after nine days off of ceftaroline.
A 67-year-old man developed profound neutropenia and agranulocytosis after three weeks of high-dose ceftaroline therapy for the treatment of MRSA septic arthritis. His neutropenia resolved after ceftaroline discontinuation and treatment with an alternative antibiotic.
报告1例与头孢洛林超说明书用药相关的严重中性粒细胞减少和粒细胞缺乏症病例。
一名67岁的白种男性因右肩疼痛及疼痛放射至右胸、背部和右臂伴无力而就诊于急诊室。症状回顾显示，患者有两天排尿烧灼感，伴有尿量减少和食欲减退。多项检查发现耐甲氧西林金黄色葡萄球菌（MRSA）败血症性关节炎，采用超说明书剂量的头孢洛林（每8小时静脉注射600mg）进行治疗。在头孢洛林治疗开始时，患者的基线绝对中性粒细胞计数（ANC）为6640个细胞/μL，到第19天时降至816个细胞/μL，在治疗第21天时最终降至0个细胞/μL。由于怀疑中性粒细胞减少是骨髓成熟停滞所致，遂停用头孢洛林。患者改用静脉注射达托霉素以完成六周的抗生素疗程。住院期间，介入放射科在患者右肩放置了引流管，症状有所改善。停用头孢洛林后，患者白细胞计数持续上升，在停用头孢洛林九天后，白细胞计数达到6.5×10³个细胞/μL，分类显示中性分叶核粒细胞占56.6%，淋巴细胞占28.4%。
一名67岁男性在接受高剂量头孢洛林治疗MRSA败血症性关节炎三周后出现严重中性粒细胞减少和粒细胞缺乏症。停用头孢洛林并换用另一种抗生素治疗后，他的中性粒细胞减少症得到缓解。
