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Antibiotics and Neutropenia dr shabeel pn www.hi-dentfinishingschool.blogspot.com
Definite <ul><li>1.Neutropenia  : </li></ul><ul><li>ANC(absolute neutrophil   count )< 500-1000/mm 3 </li></ul><ul><li>2.A...
Causes of Neutropenia <ul><li>Decreased Production </li></ul><ul><li>Peripheral Destruction </li></ul><ul><li>Peripheral P...
Decreased Production <ul><li>Drug-induced-alkylating agents  </li></ul><ul><li>Hematologic diseases  </li></ul><ul><li>Tum...
Periperal Destruction <ul><li>Antineutrophil antibodies and/or splenic or lung (alveolar macrophage) trapping  </li></ul><...
Peripheral Pool <ul><li>Overwhelming bacterial infection (acute endotoxemia)  </li></ul><ul><li>Hemodialysis  </li></ul><u...
Common Antibiotics <ul><li>1 .Penicillin  </li></ul><ul><li>2 .Cephem </li></ul><ul><li>3 .Monobactam </li></ul><ul><li>4 ...
Penicillin  類抗生素 <ul><li>1.PENICILLIN  </li></ul><ul><li>2 . AMOXICILLIN/CLAVULANIC ACID </li></ul><ul><li>(Augmentin) </l...
1.Penicillin G  induced neutropenia   <ul><li>1.Incidence : rare </li></ul><ul><li>2.Onset : 20 million units daily for 2 ...
2.Augmentin ®  induced neutropenia <ul><li>1.Incidence : rare </li></ul><ul><li>2.Onset :1.5 g Augmentin daily for 45 days...
3.Timentin®  induced neutropenia <ul><li>1.Incidence : rare </li></ul><ul><li>2.Onset : 9 days of treatment with 3.1 gram ...
4.Tazocin®  induced neutropenia <ul><li>1.Incidence : 6 % </li></ul><ul><li>2.Onset :  200 to 300 mg/kg piperacillin devel...
Cephem 類抗生素 <ul><li>1.  Cephalexin </li></ul><ul><li>2.Cefoxitin </li></ul><ul><li>3.Ceftriaxone,Cefoperazone </li></ul><u...
1.Keflex ®  induced neutropenia <ul><li>1.Incidence : 3 %  </li></ul><ul><li>2.Suggest :  allergic reactions, occurring in...
2.Zinacef ®  induced neutropenia   <ul><li>1.Incidence :  </li></ul><ul><li>1/10 decreases in hematocrit and hemoglobin  <...
3. Rocephin ®  induced neutropenia <ul><li>1.Incidence :  </li></ul><ul><li>2% , CEFTRIAXONE(ROCEPHIN ®) </li></ul><ul><li...
4. Maxipime®  induced neutropenia   <ul><li>1.Incidence :  </li></ul><ul><li>1 %  </li></ul><ul><li>2.Onset :  30 days of ...
Azactam ®  induced neutropenia <ul><li>1.Incidence :  </li></ul><ul><li>less than 1% of patients  </li></ul><ul><li>2.Onse...
CARBAPENEM 類抗生素 <ul><li>1.Imipenem(Tienam®) </li></ul><ul><li>2.Meropenem(Mepem®) </li></ul>
Tienam ®  induced neutropenia <ul><li>1.Incidence :  </li></ul><ul><li>Leukopenia ,granulocytopenia in 1% of patients  in ...
Tienam ®  induced neutropenia <ul><li>4.Suggest :  G-CSF therapy may be beneficial in the management of drug-induced agran...
Mepem ®  induced neutropenia <ul><li>1.Incidence :  case report </li></ul><ul><li>NEUTROPENIA, THROMBOCYTOPENIA, and ANEMI...
U-Gencin ®  induced neutropenia <ul><li>1.Incidence : rare  </li></ul><ul><li>2.Onset : 80 mg daily IM over a period of 1 ...
Glycopeptide 類抗生素 <ul><li>1.Vancomycin(Vancocin ®) </li></ul><ul><li>2.Teicoplanin( Targocid ®) </li></ul>
Vancocin ®  induced neutropenia <ul><li>1.Incidence :  2 % of Neutropenia, thrombocytopenia, and agranulocytosis  </li></u...
Vancocin ®  induced neutropenia <ul><li>4.Suggest :  </li></ul><ul><li>a.reversible by administration of granulocyte colon...
Targocid ®  induced neutropenia <ul><li>1.Incidence :  teicoplanin-induced leukopenia is low (0.33%)  </li></ul><ul><li>2....
Baktar ®  induced neutropenia <ul><li>1.Incidence :  P’s with AIDS would increase  the incidence of leukopenia (0.33%)  </...
Anegyn ®  induced neutropenia <ul><li>1.Incidence :  1%  leukopenia  </li></ul><ul><li>2.Onset :  unknown  </li></ul><ul><...
Take home massages <ul><li>1.Most antibiotics induced neutropenia </li></ul><ul><li>2.Careful use and WBC moniotr </li></u...
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Antibiotics And Leukopenia

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Antibiotics And Leukopenia

  1. 1. Antibiotics and Neutropenia dr shabeel pn www.hi-dentfinishingschool.blogspot.com
  2. 2. Definite <ul><li>1.Neutropenia : </li></ul><ul><li>ANC(absolute neutrophil count )< 500-1000/mm 3 </li></ul><ul><li>2.ANC<1000/mm 3 : susceptibility to infectious diseases increases . </li></ul><ul><li>3.ANC<500 /mm 3 : </li></ul><ul><li>noraml microbial flora pathogen </li></ul>
  3. 3. Causes of Neutropenia <ul><li>Decreased Production </li></ul><ul><li>Peripheral Destruction </li></ul><ul><li>Peripheral Pool </li></ul>
  4. 4. Decreased Production <ul><li>Drug-induced-alkylating agents </li></ul><ul><li>Hematologic diseases </li></ul><ul><li>Tumor invasion </li></ul><ul><li>Nutritional deficiency-vitamin B12, folate (especially alcoholics) </li></ul><ul><li>Infection </li></ul>
  5. 5. Periperal Destruction <ul><li>Antineutrophil antibodies and/or splenic or lung (alveolar macrophage) trapping </li></ul><ul><li>Autoimmune disorders- </li></ul><ul><li>Drugs as haptens- </li></ul><ul><li>Wegener's granulomatosis </li></ul>
  6. 6. Peripheral Pool <ul><li>Overwhelming bacterial infection (acute endotoxemia) </li></ul><ul><li>Hemodialysis </li></ul><ul><li>Cardiopulmonary bypass </li></ul>
  7. 7. Common Antibiotics <ul><li>1 .Penicillin </li></ul><ul><li>2 .Cephem </li></ul><ul><li>3 .Monobactam </li></ul><ul><li>4 .Carbapenem </li></ul><ul><li>5 .Aminoglycoside </li></ul><ul><li>6.Fluoroquinolone </li></ul><ul><li>7.Macrolide </li></ul><ul><li>8 .Glycopeptide </li></ul><ul><li>9 .sulfa drug </li></ul><ul><li>10 .others </li></ul>
  8. 8. Penicillin 類抗生素 <ul><li>1.PENICILLIN </li></ul><ul><li>2 . AMOXICILLIN/CLAVULANIC ACID </li></ul><ul><li>(Augmentin) </li></ul><ul><li>3. TICARCILLIN/CLAVULANIC ACID (Timentin) </li></ul><ul><li>4.PIOERACILLIN/TAZOBACTAM (Tazocin)-6% </li></ul>
  9. 9. 1.Penicillin G induced neutropenia <ul><li>1.Incidence : rare </li></ul><ul><li>2.Onset : 20 million units daily for 2 week </li></ul><ul><li>3.Recover : within 3 days </li></ul><ul><li>4.Suggest : intensive monitoring of patients with SBE receiving high dose penicillin therapy </li></ul>
  10. 10. 2.Augmentin ® induced neutropenia <ul><li>1.Incidence : rare </li></ul><ul><li>2.Onset :1.5 g Augmentin daily for 45 days </li></ul><ul><li>3.Recover : within 6 days </li></ul><ul><li>4.Suggest : WBC monitor </li></ul>
  11. 11. 3.Timentin® induced neutropenia <ul><li>1.Incidence : rare </li></ul><ul><li>2.Onset : 9 days of treatment with 3.1 gram every 6 hours for pneumonia. </li></ul><ul><li>3.Recover : within 4 days </li></ul><ul><li>4.Suggest : monitor of WBC </li></ul>
  12. 12. 4.Tazocin® induced neutropenia <ul><li>1.Incidence : 6 % </li></ul><ul><li>2.Onset : 200 to 300 mg/kg piperacillin developed neutropenia 15-23 days </li></ul><ul><li>3.Recover : 3-8 days </li></ul><ul><li>4.Suggest : be careful used in child </li></ul>
  13. 13. Cephem 類抗生素 <ul><li>1. Cephalexin </li></ul><ul><li>2.Cefoxitin </li></ul><ul><li>3.Ceftriaxone,Cefoperazone </li></ul><ul><li>4.Cefepime </li></ul>
  14. 14. 1.Keflex ® induced neutropenia <ul><li>1.Incidence : 3 % </li></ul><ul><li>2.Suggest : allergic reactions, occurring in 0.9 to 3.2% of patients. </li></ul>
  15. 15. 2.Zinacef ® induced neutropenia <ul><li>1.Incidence : </li></ul><ul><li>1/10 decreases in hematocrit and hemoglobin </li></ul><ul><li>1/750 leukopenia </li></ul><ul><li>1/100 transient neutropenia </li></ul><ul><li>2.Onset : 5 days </li></ul><ul><li>3.Recover when therapy is discontinued </li></ul><ul><li>4.Suggest : In children treated for more than 5 days, 32% and 18% developed eosinophilia and neutropenia </li></ul>
  16. 16. 3. Rocephin ® induced neutropenia <ul><li>1.Incidence : </li></ul><ul><li>2% , CEFTRIAXONE(ROCEPHIN ®) </li></ul><ul><li>1.1% ,CEFTAZIDIME(FORTUNE ®) </li></ul><ul><li>2.Onset : 21days of treatment with high dose </li></ul><ul><li>3.Recover : slowly resolved </li></ul><ul><li>4.Suggest : monitor of WBC </li></ul>
  17. 17. 4. Maxipime® induced neutropenia <ul><li>1.Incidence : </li></ul><ul><li>1 % </li></ul><ul><li>2.Onset : 30 days of therapy with cefepime 2 grams intravenously every 12 hours. </li></ul><ul><li>3.Recover : 4-7 days </li></ul><ul><li>4.Suggest : monitor of WBC </li></ul>
  18. 18. Azactam ® induced neutropenia <ul><li>1.Incidence : </li></ul><ul><li>less than 1% of patients </li></ul><ul><li>2.Onset : unknown </li></ul><ul><li>3.Recover : unknown </li></ul><ul><li>4.Suggest : PANCYTOPENIA, NEUTROPENIA, THROMBOCYTOPENIA, ANEMIA, LEUKOCYTOSIS, and THROMBOCYTOSIS </li></ul>
  19. 19. CARBAPENEM 類抗生素 <ul><li>1.Imipenem(Tienam®) </li></ul><ul><li>2.Meropenem(Mepem®) </li></ul>
  20. 20. Tienam ® induced neutropenia <ul><li>1.Incidence : </li></ul><ul><li>Leukopenia ,granulocytopenia in 1% of patients in therapeutic doses </li></ul><ul><li>2.Onset : 12.5 days . </li></ul><ul><li>3.Recover : drug withdrawal </li></ul>
  21. 21. Tienam ® induced neutropenia <ul><li>4.Suggest : G-CSF therapy may be beneficial in the management of drug-induced agranulocytosis in elderly patients. </li></ul><ul><li>American Journal of Medicine. Vol 112(6) (pp 460-464), 2002 </li></ul>
  22. 22. Mepem ® induced neutropenia <ul><li>1.Incidence : case report </li></ul><ul><li>NEUTROPENIA, THROMBOCYTOPENIA, and ANEMIA </li></ul><ul><li>2.Onset : meropenem 40 mg/kg every 8 hours for 2 weeks followed by 100 mg/kg every 8 hours for 2 weeks , </li></ul><ul><li>to treat a Morganella morgani meningitis </li></ul><ul><li>3.Recover : 2 weeks </li></ul><ul><li>4.Suggest : recommended dose of 40 mg/kg for treatment of meningitis in children </li></ul>
  23. 23. U-Gencin ® induced neutropenia <ul><li>1.Incidence : rare </li></ul><ul><li>2.Onset : 80 mg daily IM over a period of 1 week for S.aureus </li></ul><ul><li>3.Recover : 1 month </li></ul><ul><li>4.Suggest : WBC monitor </li></ul>
  24. 24. Glycopeptide 類抗生素 <ul><li>1.Vancomycin(Vancocin ®) </li></ul><ul><li>2.Teicoplanin( Targocid ®) </li></ul>
  25. 25. Vancocin ® induced neutropenia <ul><li>1.Incidence : 2 % of Neutropenia, thrombocytopenia, and agranulocytosis </li></ul><ul><li>2.Onset : (17-35 days) </li></ul><ul><li>starts 1 week more after therapy </li></ul><ul><li>after a total dosage of > 25 g </li></ul><ul><li>3.Recover : after discontinuation of therapy. </li></ul>
  26. 26. Vancocin ® induced neutropenia <ul><li>4.Suggest : </li></ul><ul><li>a.reversible by administration of granulocyte colony-stimulating factor </li></ul><ul><li>b.long- term use should monitor leukocyte counts </li></ul>
  27. 27. Targocid ® induced neutropenia <ul><li>1.Incidence : teicoplanin-induced leukopenia is low (0.33%) </li></ul><ul><li>2.Onset : (7-21) days, initial dose of 400 mg followed by 200 mg every 24 hours. </li></ul><ul><li>3.Recover : reversible after drug withdrawal </li></ul><ul><li>4.Suggest : monitor of WBC </li></ul>
  28. 28. Baktar ® induced neutropenia <ul><li>1.Incidence : P’s with AIDS would increase the incidence of leukopenia (0.33%) </li></ul><ul><li>2.Onset : 9 days of </li></ul><ul><li>TMP 20 mg/kg/day & SMX 100 mg/kg/day </li></ul><ul><li>for PCP infection in AIDS </li></ul><ul><li>3.Recover : reversible after drug withdrawal </li></ul><ul><li>4.Suggest : leucovorin ® for preventing hematologic toxicities caused by cotrimoxazole use in patients with AIDS </li></ul>
  29. 29. Anegyn ® induced neutropenia <ul><li>1.Incidence : 1% leukopenia </li></ul><ul><li>2.Onset : unknown </li></ul><ul><li>3.Recover : reversible after drug withdrawal </li></ul><ul><li>4.Suggest : used carefully </li></ul>
  30. 30. Take home massages <ul><li>1.Most antibiotics induced neutropenia </li></ul><ul><li>2.Careful use and WBC moniotr </li></ul><ul><li>3.Drug withdrawal is first choice </li></ul><ul><li>4.Don’t forget find other reason of neutropenia </li></ul>

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