Vancomycin-Induced Neutropenia during Treatment of Endocarditis in a Pediatric Patient

OBJECTIVE: To report a case of reversible vancomycin-associated neutropenia occurring during long-term therapy with vancomycin using weight and age-adjusted dosing. CASE SUMMARY: A 2-year-old boy was started on vancomycin therapy for presumed endocarditis resulting from his ventriculoseptal defect. After 18 days of treatment, neutropenia with an absolute neutrophil count (ANC) of 990 × 106 cells/L was noted. The neutropenia progressed over the next 3 days and reached a nadir concentration of 459 × 106 cells/L. Vancomycin therapy was discontinued after 17 days (antibiotic day 20). A rise in the ANC occurred within 2 days of discontinuation. An improved ANC of 1672 × 106 cells/L occurred within 5 days. Vancomycin serum concentrations remained within an acceptable range: a peak of 30 μg/mL and a trough of 9 μg/mL. DISCUSSION: Case reports in the literature of vancomycin-associated neutropenia in adults were briefly reviewed and compared. The onset and resolution and mechanism of vancomycin-induced neutropenia were studied. The potential relationship between vancomycin, weight-, and age-adjusted dosing and the occurrence of neutropenia in our pediatric patient was postulated. CONCLUSIONS: Vancomycin is identified as a possible cause of drug-induced neutropenia. More data are needed that clearly indicate vancomycin as the offending agent in children. The vancomycin-induced neutropenia is believed to be immunologically based and independent of drug concentrations.

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Thalidomide-Induced Peropheral Neuropathy in Newly Diagnosed and Pre-Treated Multiple Myeloma Patients.

Blood ◽

10.1182/blood.v104.11.4898.4898 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4898-4898

Author(s):

Patrizia Tosi ◽

Elena Zamagni ◽

Claudia Cellini ◽

Delia Cangini ◽

Paola Tacchetti ◽

...

Keyword(s):

Multiple Myeloma ◽

Term Therapy ◽

High Dose ◽

Newly Diagnosed ◽

Drug Induced ◽

Patients At Risk ◽

Pretreated Patients ◽

Grade 3 ◽

Long Term Therapy

Abstract Thalidomide is remarkably active in advanced relapsed and refractory multiple myeloma (MM), so that its use has been recently proposed either in newly diagnosed patients or as maintenance treatment after conventional or high-dose therapy. This latter therapeutic approach has risen the concern of side effects occurring after long-term therapy with this drug. In order to investigate this issue we analyzed the outcome of 74 patients who have been treated with thalidomide + dexamethasone for longer than 8 months at our Institution. Thirty-four patients (18M, 16F, median age = 55 years) had newly diagnosed symptomatic MM and were treated with four monthly courses of thalidomide 200mg/day + dexamethasone 40 mg on days 1 to 4 (even cycles), or on days 1 to 4, 9 to 12 and 17 to 20 (odd cycles), followed by cyclophosphamide 7g/m2 + G-CSF, peripheral blood stem cell (PBSC) collection, and double autologous PBSC transplant. Thalidomide + dexamethasone was administered throughout the whole treatment program. Forty patients (27M, 13F, median age = 61 years) were treated with thalidomide 200mg/day +dexamehasone 40mg on days 1–4 every four weeks as salvage therapy for relapsed (n = 14) or progressive (n=26) MM. Neurotoxicity was the most troublesome and frequent toxic effect that was observed after > 8 months treatment, the incidence averaging 74% in newly diagnosed patients and 75% in pretreated ones. Symptoms included paresthesias, tremor and dizziness; serial electromyographic studies revealed a symmetrical, mainly sensory peripheral neuropathy, with minor motor involvement. The severity of neuropathy, graded according the NCI-CTC 2.0 scoring system, varied greatly in the two groups of patients, as pretreated patients showed grade 2 and 3 toxicity in 32.5% and 27.5% of the cases, respectively, while the majority of newly diagnosed patients complained about grade 1 toxicity (57%), and none of them experienced grade 3 toxicity. In both groups thalidomide neurotoxicity was not related to sex, M protein isotype, and thalidomide daily dose. In pretreated patients, a significant correlation between grade 2 + 3 neurotoxicty and longer disease duration was found, thus suggesting that subclinical MM-related neurotoxicity could favour drug-induced toxic effects. These results suggest that long-term thalidomide therapy in MM may be hampered by the remarkable neurotoxicity of the drug, and that a neurological evaluation should be mandatory prior to thalidomide treatment, in order to identify patients at risk of developing a periperal neuropathy.

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The Acceptability, Safety and Efficacy of Nedocromil Sodium in Long-Term Clinical Use in Patients with Perennial Asthma

Journal of International Medical Research ◽

10.1177/030006058801600509 ◽

1988 ◽

Vol 16 (5) ◽

pp. 394-401 ◽

Cited By ~ 2

Author(s):

E. Carrasco ◽

R. Sepulveda

Keyword(s):

Nedocromil Sodium ◽

Dose Inhaler ◽

Term Therapy ◽

Uncontrolled Asthma ◽

Drug Induced ◽

Asthmatic Patients ◽

Assessment Study ◽

Metered Dose ◽

Long Term Therapy

The safety, acceptability and efficacy of nedocromil sodium, given by metered dose inhaler at a dosage of 4 mg four times daily, were investigated in a 52-week open assessment study of 79 perennial bronchial asthmatic patients maintained on oral bronchodilator therapy. Extensive laboratory monitoring of renal, hepatic and haematological functions before, during and at the end of the study failed to provide any evidence of drug-induced toxic effects. Nedocromil sodium was well tolerated with no serious adverse effects reported. Nineteen patients were withdrawn from the study, two complaining of sore throats and one of severe cough after nearly 1 year of treatment. The remainder were withdrawn because of intolerance to theophylline (one patient), non-cooperation (three), relocation outside the trial area (seven), onset of uncontrolled asthma (two) and pregnancy (three patients). Although this was an open assessment study, analysis of the diary card measurements and clinic assessments indicated that nedocromil sodium is an effective long-term therapy in the maintenance treatment of bronchial asthma.

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ANALYSIS OF 30 CASE REPORTS OF ACUTE POISONING WITH METFORMIN DURING LONG-TERM THERAPY

Acta Clinica Belgica ◽

10.1179/acb.2010.104 ◽

2010 ◽

Vol 65 (sup1) ◽

pp. 18-23 ◽

Cited By ~ 1

Author(s):

A. Garat ◽

E. Tresch ◽

F. Glowacki ◽

D. Allorge ◽

N. Houdret ◽

...

Keyword(s):

Case Reports ◽

Acute Poisoning ◽

Term Therapy ◽

Long Term Therapy

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Meperidine-Related Seizures Associated with Patient-Controlled Analgesia Pumps

Annals of Pharmacotherapy ◽

10.1177/106002809302700106 ◽

1993 ◽

Vol 27 (1) ◽

pp. 29-32 ◽

Cited By ~ 63

Author(s):

Kathleen O. Hagmeyer ◽

Laurie S. Mauro ◽

Vincent F. Mauro

Keyword(s):

Case Reports ◽

Review Literature ◽

Term Therapy ◽

Patient Controlled Analgesia ◽

Data Synthesis ◽

Manual Search ◽

High Doses ◽

Long Term Therapy ◽

Search Index

OBJECTIVE: To report three cases of meperidine-related seizures when meperidine was administered via patient-controlled analgesia pump (PCAP) and to review literature related to meperidine-associated seizures. DATA SOURCES: Case reports and review articles identified by a computerized search (MEDLINE) and manual search ( Index Medicus). DATA SYNTHESIS: PCAPs are being used frequently to relieve the pain of sickle cell crisis as well as pain from many other etiologies. We report three cases of meperidine-related seizures associated with its administration via PCAP. Each of the patients received either relatively high doses, long-term therapy, or both. Meperidine has been associated with seizure activity when administered via traditional routes. Previously identified risk factors for the development of meperidine-related seizures include renal failure, high meperidine dosages, and coadministration of hepatic enzyme-inducing medications or phenothiazines. CONCLUSIONS: Meperidine administered via PCAP may be associated with seizures. Optimally, an alternative analgesic should be administered when this route is used.

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Macrolides in Chronic Inflammatory Skin Disorders

Mediators of Inflammation ◽

10.1155/2012/159354 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 18

Author(s):

Abdullateef A. Alzolibani ◽

Khaled Zedan

Keyword(s):

Macrolide Antibiotic ◽

Inflammatory Diseases ◽

Case Reports ◽

Term Therapy ◽

Diffuse Panbronchiolitis ◽

Pityriasis Lichenoides ◽

Potential Benefits ◽

Disease Modifying Agents ◽

Long Term Therapy

Long-term therapy with the macrolide antibiotic erythromycin was shown to alter the clinical course of diffuse panbronchiolitis in the late 1980s. Since that time, macrolides have been found to have a large number of anti-inflammatory properties in addition to being antimicrobials. These observations provided the rationale for many studies performed to assess the usefulness of macrolides in other inflammatory diseases including skin and hair disorders, such as rosacea, psoriasis, pityriasis rosea, alopecia areata, bullous pemphigoid, and pityriasis lichenoides. This paper summarizes a collection of clinical studies and case reports dealing with the potential benefits of macrolides antibiotics in the treatment of selected dermatoses which have primarily been classified as noninfectious and demonstrating their potential for being disease-modifying agents.

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Long-Term therapy with Benzodiazepines Despite Alcohol Dependence Disorder:Seven Case Reports

American Journal on Addictions ◽

10.3109/10550499208993148 ◽

1992 ◽

Vol 1 (4) ◽

pp. 288-293 ◽

Cited By ~ 1

Author(s):

Bryon Adinoff

Keyword(s):

Alcohol Dependence ◽

Case Reports ◽

Term Therapy ◽

Long Term Therapy

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Antithrombotic Therapy for DVT/PE

Hämostaseologie ◽

10.1055/s-0038-1659983 ◽

1997 ◽

Vol 17 (03) ◽

pp. 161-162

Author(s):

Thomas Hyers

Keyword(s):

Molecular Weight ◽

Low Molecular Weight Heparin ◽

Oral Anticoagulants ◽

Cost Effective ◽

Therapeutic Agents ◽

Great Promise ◽

Term Therapy ◽

Low Molecular Weight ◽

Long Term Therapy

SummaryProblems with unfractionated heparin as an antithrombotic have led to the development of new therapeutic agents. Of these, low molecular weight heparin shows great promise and has led to out-patient therapy of DVT/PE in selected patients. Oral anticoagulants remain the choice for long-term therapy. More cost-effective ways to give oral anticoagulants are needed.

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