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Published Online, 10 April 2007, www.theannals.com, DOI 10.1345/aph.1H633.
 The Annals of Pharmacotherapy: Vol. 41, No. 5, pp. 891-894. DOI 10.1345/aph.1H633
© 2007 Harvey Whitney Books Company.
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Glycopeptide-Induced Neutropenia: Cross-Reactivity Between Vancomycin and Teicoplanin

Shu-Hwa Hsiao, BSc (Pharm)

Clinical Pharmacist, Department of Pharmacy, National Cheng Kung University Hospital, Taiwan, Republic of China

Chia-Ming Chang, MD

Physician and Clinical Assistant Professor, Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital

Jui-Chen Tsai, PhD

Department Director, Department of Pharmacy, National Cheng Kung University Hospital

Chia-Yin Lin, MS (Pharm)

Clinical Pharmacist, Department of Pharmacy, National Cheng Kung University Hospital

Li-Hsiang Liao, MS (Pharm)

Clinical Pharmacist, Department of Pharmacy, National Cheng Kung University Hospital

Wen-Liang Lin, MS (Pharm)

Clinical Pharmacist, Department of Pharmacy, National Cheng Kung University Hospital

Ta-Jen Wu, MD

Associate Professor, Department of Internal Medicine, College of Medicine, National Cheng Kung University

Reprints: Dr. Wu, Department of Internal Medicine, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd., Tainan 704, Taiwan, ROC, fax 886-6-276-6175, djwu{at}mail.ncku.edu.tw

OBJECTIVE: To report teicoplanin-related neutropenia that developed after an episode of neutropenia induced by vancomycin therapy.

CASE SUMMARY: A 57-year-old female suffered from osteomyelitis of the left humerus, with a white blood cell (WBC) count of 2.8 x 103/mm3 and absolute neutrophil count (ANC) of 0.28 x 103/mm3, occurring after 24 days of vancomycin therapy. Vancomycin was changed to teicoplanin and the agranulocytosis resolved 4 days later. However, a new episode of neutropenia, with a WBC count of 2.8 x 103/mm3 and ANC of 0.448 x 103/mm3, occurred 11 days after teicoplanin initiation. Agranulocytosis resolved 4 days following withdrawal of teicoplanin.

DISCUSSION: Because of the close time relationship between drug administration and the development of symptoms and signs, as well as between drug withdrawal and changes in WBC count and ANC, the episodes of neutropenia were suspected to be drug related. Teicoplanin-induced agranulocytosis that followed vancomycin-induced agranulocytosis suggests a possible cross-reactivity between the 2 drugs. Both reactions were categorized as probable according to the Naranjo probability scale.

CONCLUSIONS: For all patients with vancomycin-induced neutropenia, possible cross-reactivity of teicoplanin should be monitored.

Key Words: cross-reactivity, glycopeptide, neutropenia, teicoplanin, vancomycin

Published Online, April 10, 2007. www.theannals.com, DOI 10.1345/aph.1H633




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