First two cases of immune hemolytic anemia associated with ceftizoxime

BACKGROUND: Second- and third-generation cephalosporins have been associate d with immune-mediated hemolytic reactions. This report discusses two patie nts who developed clinically significant extravascular hemolysis while rece iving the third-generation cephalosporin ceftizoxime (Ceftizox). This is be lieved to be the first time hemolysis has been described in patients receiv ing this drug. STUDY DESIGN AND METHODS: Immunologic workup of drug-dependent antibodies w as performed on blood samples using drug-coated and immune complex methodol ogies. Antibody classes and titers were analyzed. RESULTS: Both the patients' sera contained anticeftizoxime that reacted wit h red cells only when ceftizoxime was added to the sera ("immune complex" m ethod). The patients recovered without complications following discontinuat ion of the drug. Each patient had IgM and IgG drug-dependent antibodies. Th e drug-induced antibodies from each patient cross-reacted with cefotaxime, which is structurally similar to ceftizoxime, but cross-reacted either weak ly or not at all with ceftriaxone, which has a more complex side chain. CONCLUSION: This report describes the first cases of immune hemolytic anemi a associated with ceftizoxime. In drug-induced hemolytic reactions, prompt recognition and discontinuation of the drug may be important factors in red ucing the chance of serious sequelae.