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Ticarcillin-induced cystitis. Cross-reactivity with related penicillins
Insights
Two children experienced urinary tract issues, including sterile pyuria and hematuria, while on ticarcillin disodium. These symptoms resemble hemorrhagic cystitis, a known complication of certain penicillin drugs.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Urology
Background:
- Semisynthetic penicillins are widely used antibiotics.
- Urinary tract complications have been associated with some penicillin therapies.
- Hemorrhagic cystitis is a known adverse effect of certain penicillins.
Observation:
- Two pediatric patients developed dysuria, sterile pyuria, and microscopic hematuria during ticarcillin disodium treatment.
- The urinary findings were similar to hemorrhagic cystitis, with a predominance of pyuria.
- One patient experienced recurrence with ticarcillin and piperacillin; another had a similar event with ticarcillin after prior carbenicillin-induced hemorrhagic cystitis.
Findings:
- Ticarcillin disodium can induce urinary tract abnormalities, including sterile pyuria and hematuria.
- The condition appears related to hemorrhagic cystitis caused by other penicillins.
- Dose reduction or switching between semisynthetic penicillins did not prevent recurrence.
Implications:
- The clinical significance of penicillin-induced cystitis requires further investigation.
- The risk of progression to interstitial nephritis from these urinary abnormalities is unknown.
- Clinicians should be aware of potential urinary side effects associated with ticarcillin and related penicillins.
Abstract:
Two children had dysuria, sterile pyuria, and microscopic hematuria develop during treatment with ticarcillin disodium. With the exception of a predominance of pyuria over hematuria, the clinical course and laboratory findings in this disorder were similar to those observed in hemorrhagic cystitis, a potential complication of the use of several semisynthetic penicillins and penicillin G potassium. One patient had urinary abnormalities develop during two courses of ticarcillin therapy and subsequently after initiation of piperacillin sodium therapy. A second patient in whom hemorrhagic cystitis due to carbenicillin disodium developed experienced this related disorder four years later when first exposed to ticarcillin. Neither reduction of the dose nor substitution of one semisynthetic penicillin for another (piperacillin for ticarcillin, ticarcillin for carbenicillin) prevented recurrence of the disorder. The clinical importance of either form of cystitis induced by semisynthetic penicillins is uncertain, as is the risk for progression to interstitial nephritis.