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Hypoprothrombinemia associated with cefmetazole
1Drug Evaluation Unit, Hennepin County Medical Center, Minneapolis, MN 55404, USA.
The Annals of Pharmacotherapy
|February 1, 1997
Summary
Cefmetazole sodium can cause hypoprothrombinemia, a bleeding risk, especially in malnourished patients. Vitamin K prophylaxis is recommended for at-risk individuals using cephalosporins with an NMTT side chain.
Area of Science:
- Pharmacology
- Clinical Medicine
- Biochemistry
Background:
- Antibiotic-associated hypoprothrombinemia is a potential adverse effect of certain cephalosporins.
- Cefmetazole sodium, a cephalosporin, has been implicated in causing hypoprothrombinemia.
- The N-methylthiotetrazole (NMTT) side chain is a suspected contributor to this adverse effect.
Observation:
- A case report details a malnourished patient with end-stage renal disease who developed elevated prothrombin time (PT) and international normalized ratio (INR) after receiving cefmetazole.
- The patient, though asymptomatic for bleeding, showed markedly elevated PT/INR values three days post-administration.
- Discontinuation of cefmetazole and administration of Vitamin K and fresh frozen plasma led to normalization of PT/INR within 24 hours.
Findings:
- The exact incidence of cefmetazole-associated hypoprothrombinemia is inconsistent in literature.
- A plausible mechanism involves the NMTT chain inhibiting vitamin K epoxide reductase in the liver.
- Risk factors include malnutrition, low albumin, poor intake, elderly status, and renal or liver dysfunction.
Implications:
- Clinicians must identify and monitor patients at risk for antibiotic-associated hypoprothrombinemia.
- Prophylactic Vitamin K administration should be considered for high-risk patients, particularly those on cephalosporins with an NMTT side chain.
- Understanding the risk factors and mechanisms is crucial for preventing and managing this adverse drug event.