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Leukopenia due to penicillin and cephalosporin homologues
Abstract:
Leukopenia is an infrequently recognized complication of penicillin-related antibiotic and cephalosporin therapy. We describe our experience with nine individuals and reviewed reports of 11 cases from the literature. Seventy-six percent of cases occurred in individuals receiving 150 mg/kg/day or more of the various penicillin and cephalosporin homologues; 67% received these high doses for two or more weeks before the onset of leukopenia. Leukopenia was unusual within the first week of antibiotic treatment. Standard medical texts often recommend blind administration with 12 to 23 g/day of these antibiotics regardless of weight. It is suggested that these antibiotics be administered according to a maximum milligram per kilogram per day dosage as is done in children. Beyond the first week of administration, careful monitoring of the blood cell count should be conducted for those receiving high doses of these antibiotics.
Insights
High doses of penicillin and cephalosporin antibiotics can cause leukopenia (low white blood cell count). Dosing should be weight-based, and blood counts monitored, especially after the first week of high-dose therapy.
Area of Science:
- Pharmacology
- Hematology
- Infectious Diseases
Background:
- Leukopenia is a rare complication associated with penicillin and cephalosporin antibiotics.
- Clinical experience with this adverse effect is limited, necessitating further investigation.
Purpose of the Study:
- To investigate the incidence and characteristics of leukopenia in patients receiving penicillin and cephalosporin antibiotics.
- To evaluate the relationship between antibiotic dosage, duration, and the development of leukopenia.
Main Methods:
- A review of nine patient cases experiencing leukopenia.
- A literature review of 11 previously reported cases of antibiotic-induced leukopenia.
- Analysis of dosage (mg/kg/day), duration of therapy, and timing of leukopenia onset.
Main Results:
- Seventy-six percent of cases involved high doses (≥150 mg/kg/day) of penicillin or cephalosporins.
- Sixty-seven percent of patients received high doses for ≥2 weeks before leukopenia onset.
- Leukopenia typically occurred after the first week of antibiotic treatment.
Conclusions:
- High-dose, prolonged therapy with penicillin and cephalosporins increases the risk of leukopenia.
- Weight-based dosing (mg/kg/day) and monitoring blood cell counts are recommended, particularly after the first week of high-dose treatment.