Vancomycin thrombocytopenia with

Reports of drug-induced thrombocytopenia have been systematically reviewed (1). Among the 98 different drugs described in 561 articles the following antibiotics were found with level I (definite) evidence co-trimoxa-zole, rifampicin, vancomycin, sulfisoxazole, cefalothin, piperacillin, methicillin, novobiocin. Drugs with level II (probable) evidence were oxytetracycline and ampicillin. 

The most common adverse events associated with teicoplanin are hypersensitivity, fever, rash, diarrhea, nephrotoxicity, and thrombocytopenia (12,13). Local reactions at the injection site include pain, redness, or discomfort after intramuscular injection, or phlebitis after intravenous injection. Erythroderma has occurred during infusion of teicoplanin with fever and hypotension. Allergic reactions have been reported with teicoplanin, with cross-reactivity between teicoplanin and vancomycin documented by in vitro studies showing IgE release by basophils in response to stimulation by both vancomycin and teicoplanin. However, known hypersensitivity to vancomycin is not a contraindication to teicoplanin. Tumor-inducing effects have not been reported. 

In trials in the USA, thrombocytopenia occurred more commonly with teicoplanin than with vancomycin, but this was almost exclusively in patients who received much larger doses than are now recommended. 

A 14-month-old girl with chronic renal insufficiency due to renal dysplasia was empirically treated with ceftazidime and vancomycin for fever. Her calculated creatinine clearance was 10 ml/minute/1.73 m. She erroneously received vancomycin 1.5 g in 3 doses 6 hours apart. Her serum creatinine concentration increased and her vancomycin concentrations remained markedly high (338 mg/1 5 hours after the third dose). The half-Ufe of vancomycin was 145 hours. Hearing loss developed. Continued charcoal hemoperfusion and hemodialysis were used to treat the disorder. Thrombocytopenia was noted as significant consequence of hemoperfusion. The patient did not fully recover her previous renal function and became dialysis dependent. The audiogram normalized by 6 months. 

Vancomycin-associated thrombocytopenia has been reported in a 72-year-old woman who was treated with gentamicin and vancomycin for infectious endocarditis due to Clostridium pseudodiphtheriticum (52). On the 4th day of treatment, the platelet count fell and reached a nadir of 14 x lO /l on day 7. Two days after withdrawal of vancomycin (day 8) the platelet count began to rise and reached 150 x lO /l within 5 days. Vancomycin-dependent antiplatelet IgG antibodies were not detected 10 days after vancomycin. 

Thrombocytopenia also developed in a 72-year-old man who was treated with vancomycin for staphylococcal sepsis after treatment with gemcitabine for metastatic pancreatic cancer (53). On day 12 thrombocytopenia developed, reached a nadir on day 18 (13 x lO /l), and did not respond to platelet transfusions. Bone-marrow megakaryocjrtes were adequate. Platelet-associated IgG and IgM were increased. Vancomycin was withdrawn on day 28, with prompt recovery of the platelet count to 136 x lO /l in 10 days. 

Vancomycin was associated with subsequent thrombocytopenia in a retrospective study that included 193 patients in a surgical trauma intensive care unit (54). 

Immunologic A 47-year-old woman developed a drug-induced hypersensitivity syndrome, rarely associated with teicoplanin, after receiving teicoplanin for 10 days [48 ]. She developed fever, lymphadenopa-thy, myalgia, raised aminotransferases and CRP, and mild neutropenia and thrombocytopenia all resolved within 7 days of drug withdrawal. She had previously developed a neutropenia after receiving vancomycin. 

In a meta-analysis of randomized controlled comparisons of Unezolid and vancomycin for Gram-positive infections, rates of toxicity, including anemia, were similar [88 ]. Thrombocytopenia was more frequent with Unezolid and nephrotoxicity with vancomydn however, treatment duration was only about 9-12 days, which may have minimized hematological toxicity. 

Hematologic Possible vancomycin-induced thrombocytopenia occurred within 15 hours of treatment with vancomycin in a 61-year-... 

Dilli D, Oguz SS, Dilmen U. A newborn with vancomycin-induced thrombocytopenia. Pharmacology 2008 82(4) 285-6. 

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