Protein Impurities and Polymers

Several authors have demonstrated the occurrence of hemagglutinating IgM and/ or IgG antibodies in patients treated with cephalothin (Abraham et al. 1968a,b Spath et al. 1971), without any evidence that such antibodies would cause harmful clinical reactions. In this, the situation resembles that with penicillin, with the exception that some cephalosporins obviously bind serum proteins to erythrocytes, a phenomenon whose immunopathological consequences are not yet entirely clear. 

Clinically, immediate hypersensitivity reactions such as urticaria or even shock have been reported by several authors, usually in patients known to be allergic to penicillins (Kabins et al. 1965 Perkins and Saslaw 1966 Merrill et al. 1966 Rothschild and Doty 1966 Thoburn et al. 1966 Girard 1968 Scholand et al. 1968 Brogard et al. 1969 Levine 1973 Spruill et al. 1974 Velasquez and Gold 1975). Maculopapular rashes (Perkins et al. 1965 Thoburn et al. 1966 Sanders et al. 1974) and drug fever (Sanders et al. 1974) have also been reported. 

Hematological disorders induced by the cephalosporins have been reported but the incidence of hemolytic anemia in no way parallels the occurrence of positive Coombs tests. Hemolytic anemia has been reported after cephalotin (Molthan 1969 Gralnick et al. 1972), cephalexin (Ford 1967 Forbes et al. 1972), and ce-phaloridine (Kaplan and Weinstein 1967) therapy. Thrombocytopenia (Sheiman et al. 1968 Gralnick et al. 1972) and granulocytopenia (Davis et al. 1964 Levin et al. 1971 Silber and Dioknoa 1973 Dicato and Ellmann 1975) have also been reported. 

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