Skip to main content
PMC home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1987 Feb;31(2):281–285. doi: 10.1128/aac.31.2.281

Coagulopathy associated with extended-spectrum cephalosporins in patients with serious infections.

R L Nichols, M A Wikler, J T McDevitt, A L Lentnek, J A Hosutt
PMCID: PMC174706  PMID: 3471181

Abstract

Patients enrolled in two double-blind multicenter studies were evaluated for the development of hypoprothrombinemia during treatment with cephalosporins. Patients with pneumonia or peritonitis received ceftizoxime, cefotaxime, or moxalactam. The incidence of hypoprothrombinemia was greater in patients with peritonitis (12 of 49) than in those with pneumonia (5 of 96; P less than 0.05). Overall, moxalactam was associated with a higher incidence of hypoprothrombinemia (13 of 52) than either ceftizoxime (1 of 43; P less than 0.05) or cefotaxime (3 of 50; P less than 0.05), and moxalactam patients incurred the highest average increase in prothrombin time (3.7 s) as compared with either ceftizoxime (0.5 s; P less than 0.05) or cefotaxime (0.9 s; P less than 0.05) patients. The occurrence of hypoprothrombinemia in moxalactam patients with peritonitis was not related to dosage, duration of therapy, age, sex, race, or renal or hepatic function. The degree of ileus was, however, strongly related to the development of coagulopathy in moxalactam-treated patients only.

Full text

PDF
281

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andrassy K., Koderisch J., Fritz S., Ritz E. New beta-lactam antibiotics and hemorrhagic diathesis: comparison of moxalactam and cefotaxime. Clin Ther. 1983;6(1):34–42. [PubMed] [Google Scholar]
  2. Barza M., Furie B., Brown A. E., Furie B. C. Defects in vitamin K-dependent carboxylation associated with moxalactam treatment. J Infect Dis. 1986 Jun;153(6):1166–1169. doi: 10.1093/infdis/153.6.1166. [DOI] [PubMed] [Google Scholar]
  3. Conly J. M., Ramotar K., Chubb H., Bow E. J., Louie T. J. Hypoprothrombinemia in febrile, neutropenic patients with cancer: association with antimicrobial suppression of intestinal microflora. J Infect Dis. 1984 Aug;150(2):202–212. doi: 10.1093/infdis/150.2.202. [DOI] [PubMed] [Google Scholar]
  4. Fainstein V., Bodey G. P., McCredie K. B., Keating M. J., Estey E. H., Bolivar R., Elting L. Coagulation abnormalities induced by beta-lactam antibiotics in cancer patients. J Infect Dis. 1983 Oct;148(4):745–750. doi: 10.1093/infdis/148.4.745. [DOI] [PubMed] [Google Scholar]
  5. Grizzle J. E., Starmer C. F., Koch G. G. Analysis of categorical data by linear models. Biometrics. 1969 Sep;25(3):489–504. [PubMed] [Google Scholar]
  6. Hochman R., Clark J., Rolla A., Thomas S., Kaldany A., D'Elia J. A. Bleeding in patients with infections. Are antibiotics helping or hurting? Arch Intern Med. 1982 Aug;142(8):1440–1442. [PubMed] [Google Scholar]
  7. Hooper C. A., Haney B. B., Stone H. H. Gastrointestinal bleeding due to vitamin K deficiency in patients on parenteral cefamandole. Lancet. 1980 Jan 5;1(8158):39–40. doi: 10.1016/s0140-6736(80)90571-1. [DOI] [PubMed] [Google Scholar]
  8. Joehl R. J., Rasbach D. A., Ballard J. O., Weitekamp M. R., Sattler F. R. Moxalactam. Evaluation of clinical bleeding in patients with abdominal infection. Arch Surg. 1983 Nov;118(11):1259–1261. doi: 10.1001/archsurg.1983.01390110017004. [DOI] [PubMed] [Google Scholar]
  9. Klippel A. P., Pitsinger B. Hypoprothrombinemia secondary to antibiotic therapy and manifested by massive gastrointestinal hemorrhage. Report of three codes. Arch Surg. 1968 Feb;96(2):266–268. doi: 10.1001/archsurg.1968.01330200104020. [DOI] [PubMed] [Google Scholar]
  10. Landis J. R., Stanish W. M., Freeman J. L., Koch G. G. A computer program for the generalized chi-square analysis of categorical data using weighted least squares (GENCAT). Comput Programs Biomed. 1976 Dec;6(4):196–231. doi: 10.1016/0010-468x(76)90037-4. [DOI] [PubMed] [Google Scholar]
  11. Lipsky J. J., Lewis J. C., Novick W. J., Jr Production of hypoprothrombinemia by moxalactam and 1-methyl-5-thiotetrazole in rats. Antimicrob Agents Chemother. 1984 Mar;25(3):380–381. doi: 10.1128/aac.25.3.380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lipsky J. J. N-methyl-thio-tetrazole inhibition of the gamma carboxylation of glutamic acid: possible mechanism for antibiotic-associated hypoprothrombinaemia. Lancet. 1983 Jul 23;2(8343):192–193. doi: 10.1016/s0140-6736(83)90174-5. [DOI] [PubMed] [Google Scholar]
  13. Natelson E. A., Brown C. H., 3rd, Bradshaw M. W., Alfrey C. P., Jr, Williams T. W., Jr Influence of cephalosporin antibiotics on blood coagulation and platelet function. Antimicrob Agents Chemother. 1976 Jan;9(1):91–93. doi: 10.1128/aac.9.1.91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Neu H. C. Good antimicrobial prescribing. Clinical uses of cephalosporins. Lancet. 1982 Jul 31;2(8292):252–255. doi: 10.1016/s0140-6736(82)90333-6. [DOI] [PubMed] [Google Scholar]
  15. Neu H. C. The in vitro activity, human pharmacology, and clinical effectiveness of new beta-lactam antibiotics. Annu Rev Pharmacol Toxicol. 1982;22:599–642. doi: 10.1146/annurev.pa.22.040182.003123. [DOI] [PubMed] [Google Scholar]
  16. Neu H. C. The new beta-lactamase-stable cephalosporins. Ann Intern Med. 1982 Sep;97(3):408–419. doi: 10.7326/0003-4819-97-3-408. [DOI] [PubMed] [Google Scholar]
  17. Pakter R. L., Russell T. R., Mielke C. H., West D. Coagulopathy associated with the use of moxalactam. JAMA. 1982 Sep 3;248(9):1100–1100. [PubMed] [Google Scholar]
  18. Panwalker A. P., Rosenfeld J. Hemorrhage, diarrhea, and superinfection associated with the use of moxalactam. J Infect Dis. 1983 Jan;147(1):171–172. doi: 10.1093/infdis/147.1.171. [DOI] [PubMed] [Google Scholar]
  19. Pineo G. F., Gallus A. S., Hirsh J. Unexpected vitamin K deficiency in hospitalized patients. Can Med Assoc J. 1973 Nov 3;109(9):880–883. [PMC free article] [PubMed] [Google Scholar]
  20. Ramotar K., Conly J. M., Chubb H., Louie T. J. Production of menaquinones by intestinal anaerobes. J Infect Dis. 1984 Aug;150(2):213–218. doi: 10.1093/infdis/150.2.213. [DOI] [PubMed] [Google Scholar]
  21. Reddy J., Bailey R. R. Vitamin K deficiency developing in patients with renal failure treated with cephalosporin antibiotics. N Z Med J. 1980 Nov 26;92(672):378–379. [PubMed] [Google Scholar]
  22. Schentag J. J., Reitberg D. P., Cumbo T. J. Cefmenoxime efficacy, safety, and pharmacokinetics in critical care patients with nosocomial pneumonia. Am J Med. 1984 Dec 21;77(6A):34–42. doi: 10.1016/s0002-9343(84)80073-x. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES