Michael Shuman1, Tammie Lee Demler, Eileen Trigoboff, Lewis A Opler. 1. Dr. Shuman is from the Department of Pharmacy, Buffalo Psychiatric Center, Buffalo, New York; Drs. Demler and Trigoboff are from Buffalo Psychiatric Center in Buffalo, New York, and with the State University of New York at Buffalo; and Dr. Opler is Professor of Clinical Psychiatry, Columbia University Medical Center, New York, New York.
Abstract
OBJECTIVE: The purpose of this study was to determine if the drop in white blood cell/absolute neutrophil count for clozapine patients on antibiotics is a normal response to the resolution of infection or if the concurrent administration resulted in an abnormal drop in blood counts and further reduction of white blood cell/absolute neutrophil below baseline prior to infection. DESIGN: This was a retrospective record review of all patients who received clozapine and antibiotics concurrently between June 30, 2010, and June 30, 2011. SETTING: Subjects included inpatients on clozapine therapy at a state psychiatric facility. PARTICIPANTS: This protocol was approved by the Institutional Review Board of record. A total of 42 patients prescribed 93 antibiotic regimens were found to meet all of the above requirements. MEASUREMENTS AND METHODS: Medications were placed into distinct groups based on approved use and mechanism of action. Pearson Correlation Coefficients were utilized and were found to be 0.409 (p<0.01), indicating that a statistically significant relationship existed between the use of systemic antibiotics and alterations in hematologic parameters. RESULTS: Each regimen was classified by specific agent as well as whether the final white blood cell/absolute neutrophil was above or below the baseline established for each patient. CONCLUSION: Antibiotics have been identified as one category of medications that may cause decreased white blood cell/absolute neutrophil counts when combined with clozapine. Our study supports the use of either ciprofloxacin or moxifloxacin as agents that may have less risk of reductions in white blood cell/absolute neutrophil counts than are seen with penicillins, cephalosporins, and other antibiotics that may ultimately require interruption or discontinuation of clozapine therapy.
OBJECTIVE: The purpose of this study was to determine if the drop in white blood cell/absolute neutrophil count for clozapinepatients on antibiotics is a normal response to the resolution of infection or if the concurrent administration resulted in an abnormal drop in blood counts and further reduction of white blood cell/absolute neutrophil below baseline prior to infection. DESIGN: This was a retrospective record review of all patients who received clozapine and antibiotics concurrently between June 30, 2010, and June 30, 2011. SETTING: Subjects included inpatients on clozapine therapy at a state psychiatric facility. PARTICIPANTS: This protocol was approved by the Institutional Review Board of record. A total of 42 patients prescribed 93 antibiotic regimens were found to meet all of the above requirements. MEASUREMENTS AND METHODS: Medications were placed into distinct groups based on approved use and mechanism of action. Pearson Correlation Coefficients were utilized and were found to be 0.409 (p<0.01), indicating that a statistically significant relationship existed between the use of systemic antibiotics and alterations in hematologic parameters. RESULTS: Each regimen was classified by specific agent as well as whether the final white blood cell/absolute neutrophil was above or below the baseline established for each patient. CONCLUSION: Antibiotics have been identified as one category of medications that may cause decreased white blood cell/absolute neutrophil counts when combined with clozapine. Our study supports the use of either ciprofloxacin or moxifloxacin as agents that may have less risk of reductions in white blood cell/absolute neutrophil counts than are seen with penicillins, cephalosporins, and other antibiotics that may ultimately require interruption or discontinuation of clozapine therapy.
Entities:
Keywords:
antibiotic; clozapine; hematology; psychiatry; schizophrenia; side effect
Authors: Daniel P Healy; Paul A Silverman; Alice N Neely; Ian Alan Holder; George E Babcock Journal: Pharmacotherapy Date: 2002-05 Impact factor: 4.705
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