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Cefepime challenge after piperacillin/tazobactam-induced thrombocytopenia

Caroline Beaulieu1, Lisa Kurczewski2, Vishal Yajnik3

  • 1Department of Pharmacy, Virginia Commonwealth University Health, 401 North 12th Street, P.O. Box 980042, Richmond, VA, 23298-0042, USA. dr.carolinebeaulieu@gmail.com.

Journal of Thrombosis and Thrombolysis
|April 11, 2019
PubMed

Insights

Piperacillin/tazobactam can cause drug-induced thrombocytopenia (DITP) through an immune response. Cefepime was safely used in a patient with piperacillin/tazobactam DITP, suggesting potential for cross-reactivity studies.

Area of Science:

  • Hematology
  • Immunology
  • Pharmacology

Background:

  • Piperacillin/tazobactam is associated with drug-induced thrombocytopenia (DITP), a severe hematologic complication.
  • The mechanism involves a humoral immune response triggered by piperacillin/tazobactam binding to platelet proteins.
  • Cross-reactivity among beta-lactam antibiotics is a concern due to structural similarities, but the specific immunogenic moiety is unknown.

Purpose of the Study:

  • To investigate the potential for cross-reactivity in piperacillin/tazobactam-induced thrombocytopenia.
  • To evaluate the safety of alternative beta-lactam antibiotics in patients with piperacillin/tazobactam DITP.
  • To highlight the need for further research into the structure-activity relationship of DITP caused by beta-lactams.

Main Methods:

  • Case report of a patient with piperacillin/tazobactam DITP.
  • Successful treatment challenge with cefepime for aspiration pneumonia.
  • Review of existing literature on beta-lactam induced thrombocytopenia and cross-reactivity.

Main Results:

  • The first reported case of piperacillin/tazobactam DITP successfully managed with cefepime.
  • Cefepime administration did not exacerbate thrombocytopenia in this patient.
  • This suggests potential tolerance or lack of cross-reactivity between piperacillin/tazobactam and cefepime in DITP.

Conclusions:

  • Cefepime may be a safe alternative in patients with piperacillin/tazobactam-induced thrombocytopenia.
  • Further studies are required to elucidate the specific structural components of piperacillin/tazobactam responsible for DITP.
  • Evaluating the safety and cross-reactivity of other beta-lactam antibiotics is crucial for clinical practice.
Keywords:
Beta-lactamsCefepimeCross reactionsPiperacillinThrombocytopenia

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