Shinohara Y T, Colbert J
Department of Pharmacy, University of California San Diego Medical Center.
Ann Pharmacother. 1994 Jun;28(6):723-6. doi: 10.1177/106002809402800607.
To report a case of reversible vancomycin-associated neutropenia occurring during long-term therapy with vancomycin using weight and age-adjusted dosing.
A 2-year-old boy was started on vancomycin therapy for presumed endocarditis resulting from his ventriculoseptal defect. After 18 days of treatment, neutropenia with an absolute neutrophil count (ANC) of 990 x 10(6) cells/L was noted. The neutropenia progressed over the next 3 days and reached a nadir concentration of 459 x 10(6) cells/L. Vancomycin therapy was discontinued after 17 days (antibiotic day 20). A rise in the ANC occurred within 2 days of discontinuation. An improved ANC of 1672 x 10(6) cells/L occurred within 5 days. Vancomycin serum concentrations remained within an acceptable range: a peak of 30 micrograms/mL and a trough of 9 micrograms/mL.
Case reports in the literature of vancomycin-associated neutropenia in adults were briefly reviewed and compared. The onset and resolution and mechanism of vancomycin-induced neutropenia were studied. The potential relationship between vancomycin, weight-, and age-adjusted dosing and the occurrence of neutropenia in our pediatric patient was postulated.
Vancomycin is identified as a possible cause of drug-induced neutropenia. More data are needed that clearly indicate vancomycin as the offending agent in children. The vancomycin-induced neutropenia is believed to be immunologically based and independent of drug concentrations.
报告1例在使用根据体重和年龄调整剂量的万古霉素进行长期治疗期间发生的可逆性万古霉素相关性中性粒细胞减少症病例。
一名2岁男孩因室间隔缺损疑似心内膜炎开始接受万古霉素治疗。治疗18天后，发现中性粒细胞减少，绝对中性粒细胞计数（ANC）为990×10⁶/L。中性粒细胞减少在接下来3天内进展，最低点浓度达到459×10⁶/L。17天后（抗生素治疗第20天）停用万古霉素。停药后2天内ANC上升。5天内ANC改善至1672×10⁶/L。万古霉素血清浓度保持在可接受范围内：峰值为30μg/mL，谷值为9μg/mL。
简要回顾并比较了文献中关于成人万古霉素相关性中性粒细胞减少症的病例报告。研究了万古霉素诱导的中性粒细胞减少症的发生、缓解及机制。推测了万古霉素、根据体重和年龄调整剂量与我们这位儿科患者中性粒细胞减少症发生之间的潜在关系。
万古霉素被确定为药物性中性粒细胞减少症的可能病因。需要更多数据明确表明万古霉素是儿童致病药物。万古霉素诱导的中性粒细胞减少症被认为是基于免疫的，且与药物浓度无关。
