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Coagulation disorders during treatment with cefazolin and rifampicin: rare but dangerous

Ines Kouki1, Clémence Montagner1, Wladimir Mauhin1

  • 1Service de Médecine Interne, Groupe Hospitalier Diaconesses - Croix Saint-Simon, 125 rue d'Avron, 75020, Paris, France.

Journal of Bone and Joint Infection
|June 4, 2021
PubMed

Insights

Severe bleeding risk is associated with cefazolin and rifampicin treatment for spondylodiscitis. Vitamin-K-dependent clotting factor deficiency can occur, necessitating pre-treatment assessment and monitoring of prothrombin time.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Pharmacology

Background:

  • Spondylodiscitis is a serious spinal infection requiring prompt antibiotic treatment.
  • Cefazolin and rifampicin are commonly used antibiotics for various infections, including spinal infections.

Observation:

  • A 79-year-old male patient with spondylodiscitis developed massive gastrointestinal bleeding.
  • The patient was undergoing treatment with cefazolin and rifampicin for an unidentified pathogen.

Findings:

  • The patient exhibited prolonged prothrombin time and severe deficiency in vitamin-K-dependent clotting factors.
  • This clinical presentation suggests a potential link between cefazolin-rifampicin therapy and acquired coagulopathy.

Implications:

  • Clinicians should be aware of the risk of severe bleeding, specifically vitamin-K-dependent clotting factor deficiency, associated with cefazolin and rifampicin combination therapy.
  • Pre-treatment assessment of coagulation status and regular monitoring of prothrombin time are recommended for patients prescribed cefazolin-rifampicin, especially those with risk factors for coagulopathy.
  • Early recognition and management of bleeding complications are crucial in patients receiving these antibiotics.

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