Division of Pediatric Infectious Diseases, Department of Pediatrics, Eskişehir Osmangazi University Medical Faculty, Eskişehir, Turkey.
Department of Pediatrics, Eskişehir Osmangazi University Medical Faculty, Eskişehir, Turkey.
Paediatr Drugs. 2021 Jan;23(1):105-110. doi: 10.1007/s40272-020-00431-1. Epub 2020 Nov 28.
Metamizole, which has antipyretic and pain-relieving properties, is generally used to treat fever in children who do not respond to paracetamol treatment. The most remarkable side effect of metamizole is that it causes myelotoxicity independently of dose. In this study, we aimed to present the clinical features of paediatric patients who developed agranulocytosis after the use of metamizole and draw attention to this side effect.
The patients who were admitted to Eskişehir Osmangazi University Faculty of Medicine Hospital, Pediatric Infectious Diseases and Pediatric Hematology Service, between January 1, 2015, and December 31, 2018, with a diagnosis of secondary agranulocytosis to metamizole use were examined retrospectively.
In all, 12 patients were included in the study; oral metamizole was used in these patients for fever reduction. The mean absolute neutrophil count was 225/mm ± 226 (0-600/mm) at admission, and the neutrophil value of 11 patients was < 500/mm. The mean length of hospitalisation of the patients was 9.92 ± 8 (3-28) days. Eight patients received intravenous antibiotic therapy and four patients received at least one of the following treatments: intravenous immunoglobulin, granulocyte colony-stimulating factor and methylprednisolone. Bone marrow aspiration examination showed neutrophil/band maturation delaying in the myeloid series with normocellular bone marrow in three patients. Hypocellularity in the bone marrow and decrease in myeloid precursors were observed in three patients. There were no fatal cases.
The development of agranulocytosis after the use of metamizole causes long-term hospitalisation and may require the use of medications in treatment management. Considering the availability of alternative options to treat fever and pain, and given the side-effect profile of metamizole, it should not be the preferred, first-line antipyretic treatment in children.
扑热息痛具有解热和止痛作用，通常用于治疗对扑热息痛治疗无反应的发热儿童。扑热息痛最显著的副作用是独立于剂量引起骨髓毒性。在本研究中，我们旨在介绍使用扑热息痛后发生粒细胞缺乏症的儿科患者的临床特征，并提请注意这种副作用。
回顾性分析 2015 年 1 月 1 日至 2018 年 12 月 31 日期间因使用扑热息痛导致继发性粒细胞缺乏症而入住埃斯基谢希尔奥斯曼加齐大学医学院儿科传染病和儿科血液科的患者。
共纳入 12 例患者，这些患者因发热而口服扑热息痛。入院时的绝对中性粒细胞计数为 225/mm±226（0-600/mm），11 名患者的中性粒细胞值<500/mm。患者的平均住院时间为 9.92±8（3-28）天。8 例患者接受静脉抗生素治疗，4 例患者接受至少一种以下治疗：静脉免疫球蛋白、粒细胞集落刺激因子和甲基强的松龙。骨髓抽吸检查显示，3 例患者骨髓中粒细胞/带成熟延迟，骨髓细胞正常。3 例患者骨髓中细胞减少，髓系前体减少。无死亡病例。
使用扑热息痛后发生粒细胞缺乏症会导致长期住院，并可能需要药物治疗管理。考虑到有替代选择来治疗发热和疼痛，并且考虑到扑热息痛的副作用特征，它不应该是儿童首选的一线解热治疗药物。
