Severe thrombocytopenia associated with alatrofloxacin

Objective: to report ther development of severe thrombocytopenia during ala trofloxcin therapy. Case summary: A 54-year-old native American women was admitted for pneumoni a after completing a 10-day course of loracarbef 200mg po bid. On admission , the woman was hypoxic (PO2 56 mm Hg) and had a platelet count of 408 x 10 (3)/mm(3.) Alatrofloxin 300mg iv piggyback qd was initiated in the emergenc y department. The patients condition gradually improved during the next thr ee days. While preparing for discharge on hospital day 4, the patient devel oped epitaxis that lasted approximately three hours. Laboratory testing rev ealed a platelet count of 7 x 10(3)/mm(3); stable red blood cell count, hem oglobin and hematocrit values; and a normal white blood cell count. Alatrof loxacin therapy was discontinued and azithromycin was initiated on hospital day 4. Methylprednisolone 125 mg iv piggyback every 12 hours was initiated on hospital day 5. The platelet count fell to 2 x 10(3)/mm(3) on hospital day 5 and then began to rise, reaching 60 x 10(3)/mm(3) when the patient wa s discharged on hospital day 8. Discussion: Numerous infections, disease related, enviromental and pharmaco logic factors may cause thrombocytopenia. Drug-induced thrombocytopenia usu ally develops during the first two weeks of therapy and resolves within one week of drug discontinuation. Thrombocytopenia occured in <1% of more than 7000 patients receiving alatrofloxacin or trovafloxacin during clinical tr ials. Conclusions: The time course of this patients development of a nd recovery from threombocytopenia suggests that it was induced by alatrofloxacin. Clin icians should monitor patients receiving alatrofloxacin or trovafloxacin fo r signs and symptoms of bleeding and thrombocytopenia.