From the FDA Drug Label
As with other cephalosporins, anaphylaxis including anaphylactic shock, transient leukopenia, neutropenia, agranulocytosis and thrombocytopenia have been reported Cephalosporin-Class Adverse Reactions In addition to the adverse reactions listed above that have been observed in patients treated with cefepime, the following adverse reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics: ... pancytopenia.
Cephalosporins and Pancytopenia: Cephalosporins, including cefepime, have been associated with pancytopenia, a condition characterized by a low count of all three types of blood cells: red blood cells, white blood cells, and platelets. This is listed under the cephalosporin-class adverse reactions, indicating that while it may not be a common side effect specifically of cefepime, it is a recognized potential adverse effect of cephalosporin antibiotics in general 1.
From the Research
Cephalosporins can cause pancytopenia, although it is a rare adverse effect, and patients taking these antibiotics should be monitored for signs of bone marrow suppression. The risk of pancytopenia associated with cephalosporins is higher with prolonged therapy, higher doses, and in patients with renal impairment, as these antibiotics are primarily eliminated through the kidneys 2.
Key Points to Consider
- Cephalosporins like cefepime, ceftriaxone, and ceftazidime have been associated with bone marrow suppression that can lead to decreased production of all blood cell lines, resulting in pancytopenia 3, 4.
- The mechanism typically involves an immune-mediated process or direct toxicity to bone marrow stem cells.
- Patients on long-term cephalosporin therapy, especially those with risk factors, should have regular blood count monitoring.
- Symptoms that may indicate pancytopenia include unusual fatigue, bleeding, bruising, or signs of infection, and patients experiencing these should seek immediate medical attention.
- If pancytopenia develops, discontinuation of the cephalosporin is usually necessary, and blood counts typically recover within 1-2 weeks after stopping the medication.
Evidence Review
The most relevant and recent evidence regarding cephalosporin-induced pancytopenia is limited, but studies such as 2 provide insight into the potential for cephalosporins to cause hematologic reactions, including pancytopenia. Other studies, like 3 and 4, discuss the side effects of cephalosporins but do not specifically focus on pancytopenia. However, they do mention that hematologic reactions are rare but can occur. Given the potential for serious morbidity and mortality associated with pancytopenia, it is crucial to approach the use of cephalosporins with caution and monitor patients appropriately.