Flucloxacillin associated neutropenia in children treated for bone and joint infections

Flucloxacillin and fusidic acid-associated neutropenia in a patient with periaortic abscess: rare side effects of commonly used antibiotics

The use of long-term antibiotics for deep-seated infections is very common, and is associated with many clinically significant side effects. In this report we describe the history of a 48-year-old man who attended West Suffolk Hospital with nausea and vomiting, and was subsequently found to have a deep-seated infection following his repeat aortic valve replacement. He completed a 7-week course of intravenous flucloxacillin and oral fusidic acid, however, prior to finishing this course a random blood test revealed a neutrophil count of zero. He was re-admitted to hospital with fever, and was treated accordingly as per the trust's neutropenic sepsis protocol with the addition of growth colony stimulating factor (GCSF). His neutrophil count recovered after 3 days and has remained within the normal range ever since.

Adverse reactions to oxacillin in hospitalized children: a prospective study

OBJECTIVES: follow-up of children exposed to oxacillin during hospitalization focusing on adverse reactions. METHODS: patients were selected from the pediatric wards of two hospitals in Fortaleza (Hospital Universitário Walter Cantídio-HUWC and Hospital Infantil Albert Sabin-HIAS) from the first oxacillin prescription with a prospective cohort study between October, 2000 and July, 2001 (HUWC) and July/2001 and March, 2002 (HIAS). Patients' follow-up was performed by daily visits to the wards and medical charts and prescription analysis. Suspected oxacillininduced adverse reactions (OxAR cases) were notified and classified according to causality and severity. Related statistic tests were completed. RESULTS: of the 130 patients exposed to oxacillin, 27 had OxAR (20.8%). Fever was the most frequent reaction (50%) followed by rash (35.7%). The majority of reactions were considered Probable, for oxacillin was the only medication involved and 92.6% of the cases had Moderate severity with the need of therapeutic interventions caused by OxAR. A significant relation between oxacillin exposure time and OxAR was determined as well as hospitalization time and the appearance of adverse reactions. Exposure time over 14 days to oxacillin was established as a risk factor for OxAR (relative risk = 5.49). CONCLUSIONS: careful administration of oxacillin in children is recommended with established treatment duration. Empiric and prolonged use must be avoided.