Journal article
A Review of β-Lactam–Associated Neutropenia and Implications for Cross-reactivity
Annals of Pharmacotherapy, Vol.55(8), pp.1037-1049
2020
Abstract
Objective:
To review the incidence, management, and current understanding of the pathophysiology of β-lactam–induced neutropenia and to critically evaluate the practicality and safety of direct substitution to an alternative β-lactam in the setting of this reaction.
Data Sources:
A literature analysis using the PubMed and Ovid search engines (July 1968 to October 2020) was performed using the search terms neutropenia, leukopenia, β-lactam, nonchemotherapy, agranulocytosis, and G-CSF (granulocyte colony-stimulating factor).
Study Selection and Data Extraction:
The included English-language studies evaluated the incidence, mechanism, and/or management of β-lactam–induced neutropenia in pediatric or adult patients.
Data Synthesis:
Drug-induced neutropenia is a well-documented adverse reaction of β-lactam antibiotics, with an incidence of approximately 10% following at least 2 weeks of intravenous therapy. However, multiple gaps in knowledge remain in the mechanism of pathophysiology and optimal management of this reaction. Both direct toxic and immune-mediated mechanisms have been implicated. Although the cornerstone of management includes cessation of the offending agent, controversy exists on the appropriateness of direct substitution or future use of an alternative β-lactam.
Relevance to Patient Care and Clinical Practice:
Given the frequency of use and superiority of β-lactams over alternative therapy for several infectious disease states, practical recommendations are needed on the management and safe use of β-lactams following β-lactam–induced neutropenia.
Conclusion:
Future use of β-lactams with differing R1 side chains, particularly those from a separate class, should not be deemed contraindicated following β-lactam–induced neutropenia and may be considered when indicated, with close laboratory monitoring.
Details
- Title
- A Review of β-Lactam–Associated Neutropenia and Implications for Cross-reactivity
- Authors/Creators
- C. Cimino (Author/Creator)B.M. Allos (Author/Creator)E.J. Phillips (Author/Creator)
- Publication Details
- Annals of Pharmacotherapy, Vol.55(8), pp.1037-1049
- Publisher
- Harvey Whitney Books Company
- Identifiers
- 991005541629507891
- Copyright
- © 2020 by SAGE Publications
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.23 Antibiotics & Antimicrobials
- 1.23.422 Antibiotic Pharmacokinetics
- Web Of Science research areas
- Pharmacology & Pharmacy
- ESI research areas
- Pharmacology & Toxicology