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Int J Clin Pharm (2011) 33:902904 DOI 10.1007/s11096-011-9571-5
CASE REPORT
Cefepime-associated thrombocytopenia in a critically ill patient
Phin Phin Lim Chee Ping Chong
Noorizan Abdul Aziz
Received: 25 May 2011 / Accepted: 26 September 2011 / Published online: 7 October 2011 Springer Science+Business Media B.V. 2011
Abstract Case: Cefepime-induced thrombocytopenia is a rare adverse event (incidence \1.0%), based on data from clinical trials. However, there is limited post-marketing surveillance documentation on thrombocytopenia associated with cefepime. We describe a 45-year-old male who was admitted to the intensive care unit after allegedly being hit by a large metal bar in the right upper chest and shoulder. Rhabdomyolysis secondary to the trauma, pneumothorax, acute renal failure, and nosocomial sepsis were subsequently diagnosed. Four days after intravenous cefepime initiation, the patient developed thrombocytopenia with platelet count dropping from 102 9 103/lL to
15 9 103/lL. Cefepime was discontinued and the platelet count normalized to 140 9 103/lL after 6 days. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship between the patients thrombocytopenia and cefepime therapy. Conclusion: Although cefepime-induced thrombocytopenia is rare, clinicians should be alert to this potential adverse effect among critically ill patients.
Keywords Adverse drug reaction Cefepime
Clinical pharmacy Intensive care unit
Thrombocytopenia
Impact of ndings on practice
Thrombocytopenia resulting from administration of cefepime have rarely been reported.
Attention is called to the possibility that administration of cefepime in critically ill patients may trigger thrombocytopenia.
The primary treatment of cefepime-induced thrombocytopenia is removal of the offending drug.
Introduction
Cefepime, a semi-synthetic fourth generation cephalosporin, is widely prescribed for treatment of numerous infections including skin, soft tissue, lower respiratory tract, urinary tract, abdominal, bacteremia, and empiric mono-therapy for febrile neutropenia [1, 2]. Compared to its predecessors, cefepime has greater potency and broader spectrum of activity against both gram positive and gram negative bacteria [1]. Additionally, cefepimes favorable toxicity prole has contributed to its widespread use in the hospital setting.
Clinical trial data revealed that rash, pruritus, diarrhea, nausea, vomiting, fever, headache, and pain at the injection site were among the common adverse effects (incidence, 1 to 10%) attributed to cefepime use [2]. Thrombocytopenia was reported in 0.1% to less than 1.0% of patients receiving cefepime in clinical trials [2]. However, there is limited...