Leukocytopenia, thrombocytopenia and fever related to piperacillin/tazobactam treatment - A retrospective analysis in 38 children with cystic fibrosis

Bone marrow suppression is an important adverse reaction to most betalactam antibiotics. Recently it was suggested that piperacillin/tazobactam (PT) a lso may cause bone marrow toxicity. We retrospectively analyzed 100 IV anti biotic treatment courses (mean duration 12.5 days) in 38 patients (median a ge 14 years) with cystic fibrosis (CF) who were treated in our hospital. Of the patients receiving PT (84%), 6 patients (18.75% of PT-treated patients , 10.3% of PT treatment courses) developed fever, malaise and headache duri ng treatment without signs of acute infection. In one patient definite thro mbocytopenia and neutropenia, in two others a milder decrease in leukocyte and thrombocyte counts was observed after the onset of fever, The events we re time- and dose-dependent occurring between day 11 and 15 of treatment. T reatment courses lasted longer (14.2 vs 11.3 days; p < 0.05) and patients h ad received a higher cumulative dose of PT (4919 +/- 1975 mg/kg b.w vs 3161 +/- 1635 mg/kg; p < 0.02, Student's t-test) in the affected group than in the unaffected group, After discontinuation of PT, fever subsided within 24 h and blood cell counts normalized,We hypothesize that these fever episode s and changes of blood parameters are related to PT therapy.