NEUTROPENIA FOLLOWING FUSIDIC ACID ADMINI STRATION - REPORT OF 5 CASES

Two cases of moderate neutropenia and 3 cases of severe neutropenia in the course of fusidic acid treatment for sepsis related to a hip prot hesis or septic osteitis are reported. Neutropenia was always observed following routine blood cell count, after a mean of 21 days' treatmen t (16 to 27 days). Moderate fever was observed only once, in a patient with profound neutropenia. A complete recovery of blood cell count wa s noted in all cases, 5 to 9 days upon discontinuation of fusidic acid . A sternal bone-marrow aspiration was performed in 4 cases, showing n ormocellularity or hypercellularity in two cases, and moderate hypopla sia of granulocytic cells. The respective roles of other treatments ar e discussed. Overall, these five cases suggest that reversible granulo cytopenia can be caused by protracted treatment with fusidic acid. Alt hough 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 o r very rarely caused neutropenia. Finally, the possibility of vancomyc in-induced neutropenia cannot be excluded in one case.