ABSTRACT
Sixty-two cases of drug-induced agranulocytosis, spontaneously reported to the regional drug monitoring centre in Lyon from 1988 to 1994, have been analysed. The mean age of patients was 58.6 years, and sex ratio was 1:1. The mean delay of onset was 46.2 days and absolute neutrophil counts (ANC) dropped below 0.1 x 10(9)/l in 73 per cent of patients. Bone marrow aspirates disclosed absence of myeloid series in 28 per cent of investigated cases. Neutrophil recovery occurred after a mean of 9.3 days, and the overall fatality rate was 6.5 per cent. Haematopoietic growth factors (HGF) were used in 11 patients with an ANC below 0.1 x 10(9)/l and/or a hypoplastic bone marrow. We have found no clear indication for a potential benefit of HGF treatment, but HGF were usually administered late during the course of neutropenia, i.e., after a mean of 6 days. The incidence rate estimated for people living in the Rhône administrative division was 3.3 per million per year, similar to that found in epidemiological studies. Drugs most frequently involved were anti-infective agents and psychotropic drugs.
Subject(s)
Agranulocytosis/chemically induced , Acute Disease , Adolescent , Adult , Adverse Drug Reaction Reporting Systems , Aged , Agranulocytosis/drug therapy , Agranulocytosis/epidemiology , Child , Child, Preschool , Colony-Stimulating Factors/therapeutic use , Female , France/epidemiology , Humans , Infant , Infant, Newborn , Male , Middle Aged , Retrospective StudiesABSTRACT
Two cases of moderate neutropenia and 3 cases of severe neutropenia in the course of fusidic acid treatment for sepsis related to a hip prothesis or septic osteitis are reported. Neutropenia was always observed following routine blood cell count, after a mean of 21 days' treatment (16 to 27 days). Moderate fever was observed only once, in a patient with profound neutropenia. A complete recovery of blood cell count was noted in all cases, 5 to 9 days upon discontinuation of fusidic acid. A sternal bone-marrow aspiration was performed in 4 cases, showing normocellularity or hypercellularity in two cases, and moderate hypoplasia of granulocytic cells. The respective roles of other treatments are discussed. Overall, these five cases suggest that reversible granulocytopenia can be caused by protracted treatment with fusidic acid. Although nine different associated drugs could also have been involved in four patients, the causal relationship was less suggestive for three of them due to chronological events. In other cases, the drugs never or very rarely caused neutropenia. Finally, the possibility of vancomycin-induced neutropenia cannot be excluded in one case.
