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A fatal case of suspected anaphylaxis with cefoperazone and sulbactam: LC-MS analysis

Kenji Tsujikawa1, Kenji Kuwayama, Hajime Miyaguchi

  • 1First Chemistry Section, National Research Institute of Police Science, 6-3-1 Kashiwanoha, Kashiwa, Chiba 277-0882, Japan. tujikawa@nrips.go.jp

Journal of Forensic Sciences
|February 19, 2008
PubMed

Insights

This case report details a fatal anaphylaxis reaction to cefoperazone and sulbactam. Postmortem blood analysis confirmed drug levels were not indicative of overdose, suggesting hypersensitivity as the cause of death.

Area of Science:

  • Pharmacology
  • Toxicology
  • Clinical Medicine

Background:

  • Cefoperazone and sulbactam combination therapy is used for moderate to severe bacterial infections.
  • Serious anaphylaxis is a rare but potential adverse drug reaction.

Observation:

  • A fatal case of suspected anaphylaxis occurred after intravenous administration of cefoperazone and sulbactam.
  • Postmortem heart blood analysis was performed to quantify drug concentrations.

Findings:

  • Liquid chromatography-tandem mass spectrometry was used to detect and quantify cefoperazone and sulbactam.
  • Detected blood concentrations of cefoperazone (0.368 microg/ml) and sulbactam (0.143 microg/ml) were below reported therapeutic and minimally inhibitory levels.
  • The cause of death was presumed to be hypersensitivity, not drug overdose.

Implications:

  • The developed analytical method is effective for detecting and quantifying cefoperazone and sulbactam in postmortem blood.
  • This methodology can aid in the forensic evaluation of suspected anaphylaxis cases involving these antibiotics.

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