Two Cases of Significant Coagulation Dysfunction Caused by Sulperazon

Sulperazon is a compound antibiotic preparation consisting of cefoperazone and sulbactam sodium. It demonstrates efficacy in treating infections caused by sensitive bacteria and is extensively utilized in clinic. The administration of sulperazon may lead to adverse reactions including allergic responses, gastrointestinal disturbances, and hepatic dysfunction. However, the occurrence of coagulation abnormalities as an adverse reaction is relatively uncommon and has not garnered adequate attention from clinicians.

Laboratory tests for diagnosing abnormal coagulation function encompass several key assessments, in-cluding blood clotting tetrachoric, D-dimer, platelet counts and function, determination of coagulation factor activity, and vitamin K. Clinicians should conduct these tests regularly based on the patient's condition and medication regimen to ensure timely intervention.

Two patients exhibited markedly prolonged prothrombin time (PT) and elevated international normalized ratio (INR) reaching critical levels during extended anti-infective therapy with sulperazon. In patient one, we measured plasma vitamin K level and coagulation factor activities. The results showed a significant decrease in vitamin K concentration and corresponding reductions in the activities of vitamin K-dependent coagulation factors (II, VII, IX, and X), resulting in prolonged PT. For patient two, upon observing an upward trend in PT, the clinician switched the antibiotic to Meropenem and initiated intramuscular vitamin K1 injections along with plasma infusions, leading to a subsequent reduction in PT.

Sulperazon, a kind of third-generation cephalosporin antibiotic, can antagonize vitamin K and cause prolonged PT. In the long-term use of sulperazone, clinicians need to closely monitor the coagulation function. If necessary, measures such as changing antibiotics, intramuscular injection of vitamin K1, and plasma transfusion can be taken empirically to prevent serious consequences.