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Hematologic abnormalities after oral trimethoprim-sulfamethoxazole therapy in children
Insights
Trimethoprim-sulfamethoxazole oral treatment in children can cause neutropenia (low white blood cell count) and thrombocytopenia (low platelet count). Close monitoring of blood counts is recommended during treatment.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Pharmacology
Background:
- Hematologic abnormalities can be a concern in pediatric patients receiving antibiotic therapy.
- Trimethoprim-sulfamethoxazole is a commonly prescribed antibiotic for various childhood infections.
- Amoxicillin trihydrate serves as a standard comparator antibiotic in pediatric treatment protocols.
Purpose of the Study:
- To prospectively evaluate the incidence of hematologic abnormalities in children treated with oral trimethoprim-sulfamethoxazole.
- To compare the rates of neutropenia and thrombocytopenia between children receiving trimethoprim-sulfamethoxazole and amoxicillin trihydrate.
- To assess the clinical course and resolution of any observed hematologic side effects.
Main Methods:
- Prospective evaluation of 50 children treated with oral trimethoprim-sulfamethoxazole for ten days.
- Comparison with a control group of 20 children with similar infections treated with amoxicillin trihydrate.
- Monitoring of leukocyte and platelet counts to detect neutropenia and thrombocytopenia.
Main Results:
- Neutropenia developed in 34% of children on trimethoprim-sulfamethoxazole versus 5% in the amoxicillin group (P < 0.001).
- Thrombocytopenia occurred in 12% of children on trimethoprim-sulfamethoxazole, with none in the amoxicillin group (P < 0.01).
- Both neutropenia and thrombocytopenia resolved spontaneously without adverse effects.
Conclusions:
- Oral trimethoprim-sulfamethoxazole is associated with a significantly higher risk of neutropenia and thrombocytopenia in children compared to amoxicillin.
- Biweekly monitoring of leukocyte and platelet counts is crucial for children receiving trimethoprim-sulfamethoxazole.
- Discontinuation of trimethoprim-sulfamethoxazole should be considered in cases of severe neutropenia or thrombocytopenia.
Abstract:
The development of hematologic abnormalities was prospectively evaluated in 50 children treated for ten days each with oral trimethoprim-sulfamethoxazole and compared with a control group of 20 children with similar infections treated with amoxicillin trihydrate. Neutropenia (polymorphonuclear neutrophilic leukocyte counts, less than or equal to 1,500/cu mm) developed in 17 (34%) of the 50 children treated with trimethoprim-sulfamethoxazole compared with one (5%) in the control group of 20 children (P less than 0.001). Thrombocytopenia (platelet count, less than 150,000/cu mm) developed in six (12%) of the children treated with trimethoprim-sulfamethoxazole, but it did not develop in any of the amoxicillin-treated children (P less than .01). Neutropenia occurred mostly during the first week of treatment and lasted a mean of 8.9 days. Thrombocytopenia was noted between the seventh and 16th day (mean, 10.3 days) and lasted a mean of 12.7 days. Both side effects resolved spontaneously without ill effects. Children treated with oral trimethoprim-sulfamethoxazole should be followed up with biweekly leukocyte and platelet counts, and treatment should be discontinued if severe neutropenia or thrombocytopenia develops.