Leukopenia and thrombocytopenia due to metronidazole treatment in a case with acute gastroenteritis

Year 2017, , 32 - 34, 16.03.2017

Özlem Özel Salih Cesur Çiğdem Ataman Hatipoğlu Şerife Altun Demircan Esra Kaya Kılıç Sami Kınıklı Ali Pekcan Demiröz

https://doi.org/10.18663/tjcl.298245

Abstract

In cases with
gastroenteritis, the treatment is based on fluid and electrolyte replacement.
Antibacterial or antiparasite therapy could be given in cases where bacterial
or parasite microorganism is possible. However metronidazole therapy should not
be initiated empirically without parasitological evaluation of the feces.
Metronidazole is an antianaerobic and antiprotozoal effective drug and although
it is well tolerated, it can cause hematological and neurological adverse
effects in some patients.

Herein, we report an 84
years old male who has given metronidazole therapy with the diagnosis of acute
gastroenteritis and developed leukopenia and thrombocytopenia as side effects
of the therapy. It must be kept in mind that hematologic side effects such as
neutropenia and thrombocytopenia could occur during or after the metronidazole
therapy and those patients should be followed
closely.  

Keywords

Acute gastroenteritis, metronidazole, thrombocytopenia, leukopenia, adverse effect

Metronidazol tedavisine bağlı olarak lökopeni ve trombositopeni gelişen akut gastroenterit olgusu

Abstract

Akut gastroenteritlerde
tedavinin esası sıvı-elektrolit replasmanıdır. Bakteriyel veya paraziter etken
düşünülen olgularda ise antibiyotik veya antiparaziter tedavi uygulanabilir.
Gaitanın parazitolojik yönden incelemesi yapılmadan ampirik olarak metronidazol
tedavisi başlanmamalıdır. Metronidazol antianaerobik ve antiprotozoal etkili
bir ilaçtır, iyi tolere edilmesine rağmen bazı hastalarda hematolojik ve nörolojik
yan etkilere neden olabilmektedir.

Bu yazıda akut
gastroenterit tanısıyla metronidazol tedavisi başlanan ve metronidazole bağlı
yan etki olarak lökopeni ve trombositopeni gelişen 84 yaşında bir olgu
sunulmuştur. Metronidazol tedavisi sırasında veya sonrasında lökopeni,
trombositopeni gibi ilaca bağlı hematolojik yan etkilerin gelişebileceği akılda
tutulmalı ve yan etki gelişen hastalar yakından takip edilmelidir.

Keywords

Akut gastroenterit, metronidazol, lökopeni, trombositopeni, yan etki

References

• Ulutan F. Akut ishalli hastaya yaklaşım. Willke A, Söyletir G, Doğanay M (edi), Enfeksiyöz ishaller, Enfeksiyon Hastalıkları ve Mikrobiyolojisi, 3. baskı,Nobel Tıp Kitabevleri, İstanbul, 2008; s. 1045-1078.
• Ohniski K, Sakamoto N, Subjective adverse reaction to metronidazole in patients with amebiasis. Parasitology international 2014; 63:698-700.
• Jenks PJ. Nitroimidazoles, In: Antibiotic and chemotherapy, Roger G. Finch,David Greenwood,Richard J, Whitley,S. Ragnar Norrby (eds). 9nd ed.Philadelphia: Saunders Company; 2010: 292-300.
• Nagel JL, Aranoff DM. Metronidazole. Mandell, Bennett, Douglas (Eds), Principles and Practice of Infectious Diseases, 8th edi, Philadelphia, Saunders Company, 2015; 353-354.
• Vudalı E, Kınıklı S, Cesur S. Antibiyotiklerin yan etkileri. Turk J Clin Lab 2014; 5: 18-27.
• Gilbert D, Moellering RC, Eliopoulos GM, Chambers HF, Saag MS. The Sanford Guide to Antimicrobial therapy 2012; 42nd edition, p.97-106.
• Granowitz EV, Brown RB. Antibiotic adverse reactions and drug interactions. Crit Care Clin 2008; 24: 421-42.
• Smith JA. Neutropenia associated with metronidazole therapy. Can Med Assoc J 1980; 123: 202.
• Martin C, Ruperti A, Saux P, Brioche MI, Gouin F. Drug-induced agranulocytosis. Discussion of the responsibility of metronidazole. Ann Fr Anesth Reanim 1985; 4: 521-3.
• White CM, Price JJ, Hunt KM. Bone marrow aplasia associated with metronidazole. Br Med J 1980; 280: 647.
• McKendrick MW, Geddes AM. Neutropenia associated with metronidazole. Br Med J 1979; 2: 795.
• Gutiérrez García M, López Lunar E, Fernández Arenas O, Hidalgo Correas FJ, García Díaz B. Neutropenia induced by therapeutic doses of intravenous metronidazole. Farm Hosp 2009; 33: 231-3.
• Aster RH, Curtıs BR, Mcfarland JG, Bougıe DW. Drug-induced immune thrombocytopenia: pathogenesis, diagnosis, and management. J Thromb and Haemost 2009; 7: 911-8.