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Hypoprothrombinemia associated with cefoperazone therapy
R J Mueller1, D Green, J P Phair
1Department of Medicine, Rehabilitation Institute of Chicago, Ill.
Abstract:
Cefoperazone, a beta-lactam antibiotic with a methylthiotetrazole side chain, has been reported infrequently to cause hypoprothrombinemia and hemorrhage. We retrospectively analyzed the records of 80 patients who had been given this drug for more than 72 hours. Nine patients received vitamin K1 (phytonadione) prophylaxis and had no evidence of hemorrhage. Of the remaining 71 patients, 32 had prothrombin times measured; 14 of them had hypoprothrombinemia. Prothrombin times ranged from 14.8 to 97.3 seconds at a mean of 6.2 days after initiation of therapy. Seven of the 14 patients had clinically significant hemorrhage and five required transfusions. Two patients with clinically evident hemorrhage died during or immediately after cefoperazone therapy. Prothrombin times rapidly returned to normal in all patients treated with phytonadione. We believe hypoprothrombinemia is a more common complication of cefoperazone therapy than is generally acknowledged, and is preventable. Unless clinically contraindicated, we recommend that all patients treated with cefoperazone receive phytonadione prophylaxis.
Insights
Cefoperazone antibiotic use can cause bleeding due to low prothrombin levels. Vitamin K1 (phytonadione) prophylaxis effectively prevents this serious complication in patients receiving cefoperazone.
Area of Science:
- Pharmacology
- Internal Medicine
- Infectious Diseases
Background:
- Cefoperazone, a beta-lactam antibiotic, is associated with rare reports of hypoprothrombinemia and hemorrhage.
- The methylthiotetrazole side chain of cefoperazone is implicated in these adverse effects.
Purpose of the Study:
- To retrospectively analyze the incidence of hypoprothrombinemia and hemorrhage in patients treated with cefoperazone.
- To evaluate the efficacy of vitamin K1 (phytonadione) in preventing these complications.
Main Methods:
- Retrospective analysis of 80 patients receiving cefoperazone for over 72 hours.
- Comparison of outcomes between patients receiving vitamin K1 prophylaxis and those who did not.
- Measurement of prothrombin times in a subset of patients.
Main Results:
- Fourteen of 32 patients (43.8%) not receiving prophylaxis developed hypoprothrombinemia.
- Seven of these 14 patients experienced clinically significant hemorrhage, with two fatalities.
- No hemorrhage was observed in the nine patients who received vitamin K1 prophylaxis.
Conclusions:
- Hypoprothrombinemia and hemorrhage are more common complications of cefoperazone therapy than previously acknowledged.
- Vitamin K1 (phytonadione) prophylaxis is effective in preventing cefoperazone-induced hypoprothrombinemia and hemorrhage.
- Routine phytonadione prophylaxis is recommended for patients receiving cefoperazone unless contraindicated.