From the Guidelines
Elevated neutrophils typically require medical evaluation to determine the underlying cause rather than immediate treatment, as they can indicate a range of conditions from bacterial infections to more serious diseases like leukemia. When considering the management of elevated neutrophils, it's crucial to understand that neutrophils play a critical role in host defense against infection, particularly bacterial and fungal infections 1. The presence of elevated neutrophils, also known as neutrophilia, can be a response to various stimuli, including infections, inflammation, stress, and certain medications.
Key Considerations
- Neutrophils are essential for providing host defense against infection, and their elevation often represents the immune system responding to a threat 1.
- Common causes of elevated neutrophils include bacterial infections, inflammation, stress, and certain medications like corticosteroids.
- More serious conditions, such as leukemia, can also cause an increase in neutrophil count.
- Treatment should be directed at the underlying condition rather than the neutrophil count itself, which may involve antibiotics for bacterial infections or anti-inflammatory medications for inflammatory conditions.
Clinical Approach
In clinical practice, the approach to a patient with elevated neutrophils involves a thorough evaluation to identify the underlying cause. This may include additional tests and monitoring for symptoms such as fever, fatigue, or pain, which could provide clues about the cause. It's also important to consider the context in which the elevated neutrophils are observed, as this can significantly influence the differential diagnosis and subsequent management plan. For instance, in patients undergoing cytotoxic chemotherapy or hematopoietic stem-cell transplantation, the risk of infection is heightened, particularly during periods of neutropenia, and the management strategy would need to take this into account 1.
From the Research
Elevated Neutrophils
- Elevated neutrophils can be a sign of infection or inflammation in the body 2
- Neutropenia, or low neutrophil count, can be a side effect of certain medications, such as ceftriaxone 3, 4
- Ceftriaxone-induced neutropenia is a rare but severe adverse effect that usually resolves within one to three weeks after cessation of the drug 3
- In some cases, patients who develop ceftriaxone-induced neutropenia can be safely treated with alternative β-lactam antibiotics, such as ampicillin sodium, without causing cross-reactivity 3
Neutrophil Count and Infection
- Neutrophil count is an important factor in determining the risk of infection, particularly in patients with compromised immune systems 5
- Febrile neutropenia is a common complication in patients undergoing chemotherapy, and antibacterial prophylaxis is often used to prevent infection 5
- The incidence of febrile neutropenia was similar between patients receiving levofloxacin and those receiving oral third-generation cephalosporins as antibacterial prophylaxis 5
Ceftriaxone and Neutropenia
- Ceftriaxone is a third-generation cephalosporin that is commonly used to treat bacteremia and other infections 6, 4
- The optimal dose of ceftriaxone for treating bacteremia is not well established, and clinical failure rates have been reported to be similar between 1g and 2g daily doses 6
- Ceftaroline, another cephalosporin, has been associated with a higher risk of neutropenia compared to ceftriaxone, particularly with prolonged use 4