Cephalosporins

Coagulation abnormalities and haemorrhage: incidence Some cephalosporins and semisynthetic penicillins may affect platelet aggregation and coagulation and cause hypoprothrombinaemia, perhaps because of the elimination of vitamin-K producing microbes from the 01 tract. The frequency and severity of coagulation abnormalities were examined retrospectively in 714 immunocompromised, neutropenic cancer patients who were treated with a number of antibiotic regimens. 13 evaluable patients received 18 gjday azlocillin + 18 gjday cefamandole, and 8 developed prolonged prothrombin time (PT), activated partial thromboplastin time (APTT) or thrombin time (TT). Seven showed 'mild' abnormalities and had a 'severe' abnormality. This patient also developed se'Vere GI haemorrhage. 49 patients received 18 gjday azlocillin + 12 gjday cefamandole. 33 developed some abnormality, usually prolongation of PT (21 patients), 3 patients had mild haemorrhage (gums, skin and injection site), and 1 developed severe pulmonary haemorrhage. The combination of azlocillin (18 g/day) + cefoxitin (12 gjday) produced mild abnormalities in IOjS3 patients, and severe abnormalities in 4/53, but no haemorrhages occurred. However, the combination of azlocillin, tobramycin and co-trimoxazoIe (trimethoprim + sulfamethoxazole) produced only mild abnormalities in 6/40 patients, with no episodes of haemorrhage. Of 52 patients who received carbenicillin (30 g/day) + cefamandole (12 gfday) 19 had mild and 6 had severe abnormalities, and 5 suffered mild or severe haemorrhage. Latamoxef (moxalactam; Iamoxactam) 12 g,lday + ticarcillin 24 gjday produced mild abnormalities in 3% of 33 patients, severe abnormalities in 6%, and severe haemorrhage in 6%, while latamoxef + tobramycin caused 4% mild abnormalities. II % severe abnormalities and 11% severe' haemorrhage (28 patients). 281 patients received prophylactic vitamin K during treatment with a latamoxef combination, and none of these experienced any abnormalities or haemorrhage. Thus, it appears that cephalosporins ra ther than penicillins, are primarily responsible for coagulation abnormalities in neutropenic patients, so vitamin K supplementation and regular monitoring of coagulation are recommended. Fainslein. V. el a!.: Journal of Infectious Diseases 148: 745 (Ocl 1983)

4 Reactions 9 Dec 1983 0157-7271/83/1209-0004{0$01.00{0 ., ADIS presS