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Reversible neutropenia associated with ampicillin therapy in pediatric patients
Abstract:
Hematologic abnormalities associated with penicillin compounds are uncommon, and neutropenia associated with ampicillin is reported even less frequently. Neutropenia developed in three pediatric patients after high-dose (150-400 mg/kg) ampicillin therapy over a period of 3 to 12 days. In all cases, the white blood cell and neutrophil counts returned towards normal within 4 to 11 days after discontinuation of the antibiotic. Bone marrow examination revealed a maturation arrest in one and slight shift to the left in the maturation of granulocytic cells in another. Other marrow components were normal. Red blood cells, reticulocytes, platelets, and hemoglobin did not show any abnormal alteration in any of the patients. Physicians administering ampicillin, particularly in high doses, should be alert to the possible development of neutropenia; however, all reported neutropenias have been reversible.
Insights
High-dose ampicillin can cause neutropenia (low neutrophil count) in children. This condition is rare but reversible after discontinuing the antibiotic treatment.
Area of Science:
- Pediatric Hematology
- Pharmacology
- Clinical Toxicology
Background:
- Penicillin compounds are rarely associated with hematologic abnormalities.
- Neutropenia, a decrease in neutrophils, is an infrequent side effect of ampicillin therapy.
Observation:
- Three pediatric patients developed neutropenia following high-dose ampicillin treatment (150-400 mg/kg/day) over 3–12 days.
- Bone marrow examinations indicated maturation arrest or a left shift in granulocytic cell maturation.
- Other hematologic parameters, including red blood cells and platelets, remained unaffected.
Findings:
- Neutropenia resolved in all patients within 4–11 days after ampicillin cessation.
- The observed neutropenia was reversible, with neutrophil counts normalizing post-treatment.
Implications:
- Clinicians should monitor for neutropenia in pediatric patients receiving high-dose ampicillin.
- Awareness of this potential adverse effect is crucial for safe antibiotic administration.
- Prompt recognition and discontinuation of ampicillin can lead to full recovery.