Severe Myelosuppression Induced by Piperacillin/Tazobactam: A Case Report
Abstract
This case report presents an elderly patient who developed severe bone marrow suppression following the administration of Piperacillin/Tazobactam. The patient exhibited a declining trend in platelet and white blood cell counts during Piperacillin/Tazobactam treatment. Subsequently, upon discontinuation of Piperacillin/Tazobactam, platelet and white blood cell counts gradually increased. Negative drug allergy test results and the absence of evidence for bone marrow suppression caused by platelet antibodies or other drugs led to the consideration of the possibility of immune-mediated bone marrow suppression induced by Piperacillin/Tazobactam. This report emphasizes the importance of close monitoring of hematological parameters to mitigate the risk of bone marrow suppression during the clinical use of Piperacillin/Tazobactam.
References
[1] Wong JC, Au EY, Yeung HH, Lau CS, Li PH. Piperacillin-Tazobactam Allergies: An Exception to Usual Penicillin Allergy. Allergy
Asthma Immunol Res. 2021 Mar;13(2):284-294.
[2] Gage-Brown A, George C, Maleki J, Singh KP, Muhi S. Is Piperacillin-Tazobactam an Appropriate Empirical Agent for Hospi_x005ftal-Acquired Sepsis and Community-Acquired Septic Shock of Unknown Origin in Australia? Healthcare (Basel). 2022 May 5;10(5):851.
[3] Hagel S, Fiedler S, Hohn A, Brinkmann A, Frey OR, Hoyer H, Schlattmann P, Kiehntopf M, Roberts JA, Pletz MW; TARGET
Study Group. Therapeutic drug monitoring-based dose optimisation of piperacillin/tazobactam to improve outcome in patients with sepsis
(TARGET): a prospective, multi-centre, randomised controlled trial. Trials. 2019 Jun 6;20(1):330.
[4] ElSalem S, Elawad S, Ahmed A, AlSaadi M, AlHail M. A case of probable piperacillin/tazobactam-induced bone marrow suppression in a pregnant woman. Eur J Hosp Pharm. 2019 May;26(3):170-172. doi: 10.1136/ejhpharm-2017-001243.
[5] Lee KW, Chow KM, Chan NP, Lo AO, Szeto CC. Piperacillin/tazobactam Induced Myelosuppression. J Clin Med Res. 2009
Apr;1(1):53-5. doi: 10.4021/jocmr2009.03.1227.
[6] Al-Sardi M, Ali H, Handoo F, AlJawad M. A Rare Case of Rapid Onset Thrombocytopenia Induced by Piperacillin/Tazobactam in
a Liver Transplant Recipient. Cureus. 2021 Sep 15;13(9):e18000. doi: 10.7759/cureus.18000.
[7] Yang R, Liu H, Bai C, Wang Y, Zhang X, Guo R, Wu S, Wang J, Leung E, Chang H, Li P, Liu T, Wang Y. Chemical composition
and pharmacological mechanism of Qingfei Paidu Decoction and Ma Xing Shi Gan Decoction against Coronavirus Disease 2019 (COVID-19):
In silico and experimental study. Pharmacol Res. 2020 Jul;157:104820. doi: 10.1016/j.phrs.2020.104820. Epub 2020 Apr 29.
[8] Zeng C, Yuan Z, Zhu J, Wang Y, Xie Y, Ye R, Cheng J. Therapeutic effects of traditional Chinese medicine (Maxingshigan-Weijing Decoction) on COVID-19: An open-label randomized controlled trial. Integr Med Res. 2021;10(Suppl):100782. doi: 10.1016/
j.imr.2021.100782. Epub 2021 Oct 12.
[9] He Z-F, Wu X-A, Wang Y-P. Severe bone marrow suppression and hepatic dysfunction caused by piperacillin/tazobactam. Scand J
Infect Dis 2013;45:885–7. 10.3109/00365548.2013.805426
[10]Peralta FG, Sanchez MB, Roiz MP, Pena MA, Tejero MA, Arjona R. Incidence of neutropenia during treatment of bone-related
infections with piperacillin-tazobactam. Clin Infect Dis. 2003;37(11):1568–1572.
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