Acute localized exanthematous pustulosis caused by cefoperazone and sodium sulbactam

Abstract Acute localized exanthematous pustulosis is a localized variant of acute generalized exanthematous pustulosis, which is characterized by the eruption of multiple scattered pustules following drug administration. A 72-year-old woman presented with multiple erythematous pustules on her face, which had appeared two days after using cefoperazone and sodium sulbactam. Histopathological findings showed subcorneal pustules and mixed inflammatory cell infiltration in the dermis. The pustules resolved within about two weeks after the patient discontinued the antibiotics. This report discusses the case of a woman with a cutaneous drug reaction consistent with acute localized exanthematous pustulosis that occurred after cefoperazone and sodium sulbactam were administered.

A Case of Immune Hemolytic Anemia Induced by Ceftizoxime and Cefobactam (Sulbactam/Cefoperazone) / 대한진단검사의학회지

Simultaneous drug-induced immune hemolytic anemia (DIIHA) caused by multiple drugs is rare. We report a case of a patient who developed DIIHA caused by 2 drugs. The patient's serum exhibited agglutination of ceftizoxime- or sulbactam-coated red blood cells (RBCs; via a drug-adsorption mechanism) and of uncoated RBCs in the presence of sulbactam (via an immune-complex mechanism). Although ceftizoxime is known to exhibit a positive reaction by an immune-complex method with or without reactivity with drug-coated RBCs, this patient's antibodies were reactive only against drug-coated RBCs. On the other hand, sulbactam, which is known to cause hemolytic anemia by nonimmunologic protein adsorption, exhibited positive reactions in tests with both drug-coated RBCs and in the presence of sulbactam. This is the first report of DIIHA due to a sulbactam-cefoperazone combination and the fourth report of DIIHA due to ceftizoxime. Owing to the patient's complicated laboratory results, DIIHA was suspected only at a late stage. We propose that for the prompt diagnosis of DIIHA, tests for all possible causative drugs should be conducted by 2 methods.

Cefoperazone: an analysis of results in the pediatric population from a post-marketing surveillance study in hospitalized patients. The Cefoperazone Collaborative Post-marketing Surveillance Study Group.

The injectable third-generation cephalosporin, cefoperazone, was introduced in India in early 1994. A post-marketing surveillance study was conducted in 1994-95 to collect local data on efficacy and safety, evaluate the native pattern of bacterial susceptibility, and assess the relationship of in vitro susceptibility tests to clinical efficacy. Hospitalized patients with features suggestive of infections that are approved indications for cefoperazone were eligible for the study. This report presents an analysis of the results among patients in the pediatric age group. The recommended dose range for children was 50-200 mg/kg/day. At analysis, 95 patients aged 6 days to 14 years were evaluable for efficacy. About a third of these (31%) were judged to have hospital acquired infections, and 22 (23%) had failed prophylaxis or previous treatment. A successful clinical outcome was observed in 91% of 75 non-neutropenic patients. Eighteen (95%) of 19 patients with pneumonia and 8 (89%) of 9 patients with pyogenic meningitis responded to cefoperazone. Five of 6 patients with complicated or hospital-acquired upper urinary tract infections, 2 of 3 patients with peritonitis, and all patients with skin or soft tissue infections, intra-abdominal abscess, osteomyelitis, and brain abscess also responded. Four of 5 non-neutropenic patients with septicemia recovered with cefoperazone monotherapy. The response rate was 70% among 20 neutropenic patients, 16 of whom were deemed septicemic. Antibiotic disc susceptibility data among pediatric patients was available for 63 isolates and 13% were reported resistant to cefoperazone. Microbiologic eradication was reported with 94% of initial isolates. Mild to moderate adverse events of study, drug-related or uncertain causation occurred in 4 (3.7%) of patients.

Nefrite intersticial induzida por drogas / Interstitial nephritis induced by drugs

Sao relatados quatro casos sugestivos de nefrite intersticial aguda relacionados ao uso de antibióticos, em pacientes internados na enfermaria de Clínica Médica do Hospital Universitário Lauro Wanderley, no período de abril de 1992 a janeiro de 1993. Os pacientes foram admitidos com quadro infeccioso grave, receberam antibióticos beta-lactâmicos, desenvolvendo, no curso do tratamento, síndrome de hipersensibilidade caracterizada por febre, exantema, eosinofilia e alteraçoes urinárias. Concomitantemente, foi realizada revisao da literatura a cerca do assunto, discutindo-se sua etiopatogenia e tratamento.