Advertisement

International Journal of Clinical Pharmacy

, Volume 33, Issue 6, pp 902–904 | Cite as

Cefepime-associated thrombocytopenia in a critically ill patient

  • Phin Phin Lim
  • Chee Ping ChongEmail author
  • Noorizan Abdul Aziz
Case Report

Abstract

Case: Cefepime-induced thrombocytopenia is a rare adverse event (incidence <1.0%), based on data from clinical trials. However, there is limited post-marketing surveillance documentation on thrombocytopenia associated with cefepime. We describe a 45-year-old male who was admitted to the intensive care unit after allegedly being hit by a large metal bar in the right upper chest and shoulder. Rhabdomyolysis secondary to the trauma, pneumothorax, acute renal failure, and nosocomial sepsis were subsequently diagnosed. Four days after intravenous cefepime initiation, the patient developed thrombocytopenia with platelet count dropping from 102 × 103/μL to 15 × 103/μL. Cefepime was discontinued and the platelet count normalized to 140 × 103/μL after 6 days. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship between the patient’s thrombocytopenia and cefepime therapy. Conclusion: Although cefepime-induced thrombocytopenia is rare, clinicians should be alert to this potential adverse effect among critically ill patients.

Keywords

Adverse drug reaction Cefepime Clinical pharmacy Intensive care unit Thrombocytopenia 

Notes

Conflict of interest

The authors have no conflicts of interest in connection with this paper.

References

  1. 1.
    Yahav D, Paul M, Fraser A, Sarid N, Leibovici L. Efficacy and safety of cefepime: a systematic review and meta-analysis. Lancet Infect Dis. 2007;7:338–48.PubMedCrossRefGoogle Scholar
  2. 2.
    Bristol-Myers Squibb Company. Product information: MAXIPIME® IV, IM injection, cefepime HCl IV, IM injection. Princeton: Bristol-Myers Squibb Company. http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/050679s032lbl.pdf (2009). Accessed 18 Jan 2011.
  3. 3.
    Whitby DH, Johns TE. Drug-induced hematologic disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy. A pathophysiologic approach. 7th ed. New York: McGraw-Hill Companies, Inc.; 2008. pp. 1701–1714. (ISBN 978-0-07-147899-1).Google Scholar
  4. 4.
    Gralnick HR, Mcginniss M, Halterman R. Thrombocytopenia with sodium cephalothin therapy. Ann Intern Med. 1972;77(3):401–4.PubMedGoogle Scholar
  5. 5.
    Lown JA, Barr AL. Immune thrombocytopenia induced by cephalosporins specific for thiomethyltetrazole side chain. J Clin Pathol. 1987;40:700–1.PubMedCrossRefGoogle Scholar
  6. 6.
    Großjohann B, Eichler P, Greinacher A, Santoso S, Kroll H. Ceftriaxone causes drug-induced immune thrombocytopenia and hemolytic anemia: characterization of targets on platelets and red blood cells. Transfusion. 2004;44(7):1033–40.PubMedCrossRefGoogle Scholar
  7. 7.
    Onodera M, Fujino Y, Inoue Y, Kikuchi S, Endo S. Hematoma of the iliopsoas muscle due to thrombocytopenia resulting from the administration of a third-generation cephalosporin. Ann Hematol. 2010;89:825–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.PubMedCrossRefGoogle Scholar
  9. 9.
    George JN, Raskob GE, Shah SR, Rizvi MA, Hamilton SA, Osborne S, et al. Drug-induced thrombocytopenia: a systematic review of published case reports. Ann Intern Med. 1998;129(11):886–90.PubMedGoogle Scholar
  10. 10.
    Wazny LD, Ariano RE. Evaluation and management of drug-induced thrombocytopenia in the acutely ill patient. Pharmacotherapy. 2000;20(3):209–307.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Phin Phin Lim
    • 1
  • Chee Ping Chong
    • 1
    Email author
  • Noorizan Abdul Aziz
    • 2
  1. 1.Discipline of Clinical Pharmacy, School of Pharmaceutical SciencesUniversiti Sains MalaysiaMindenMalaysia
  2. 2.Faculty of PharmacyUniversiti Teknologi Mara (UiTM)Bandar Puncak AlamMalaysia

Personalised recommendations