Azithromycin-Related Bicytopenia: An Exceptional Adverse Effect

  • Fatma Hammami Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Salma Fourati Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Makram Koubaa Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Fatma Smaoui Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Khaoula Rekik Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Chakib Marrakchi Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
  • Mounir Ben Jemaa Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
Keywords: Azithromycin, anemia, side effects, thrombocytopenia

Abstract

Macrolide antibiotics are commonly prescribed and are usually well tolerated. Azithromycin-related anemia and thrombocytopenia has not been reported previously. Here, we present the case of a 63-year-old man with bicytopenia following azithromycin treatment for ocular toxoplasmosis. He developed both thrombocytopenia and anemia after less than 7 days of treatment. Pyrimethamine, known for its hematologic side effects, was stopped on admission. However, the platelets drop continued to worsen. Then, azithromycin has been incriminated. All his symptoms and laboratory abnormalities were recovered within 7 days after the discontinuation of azithromycin treatment. Physicians must be aware of azithromycin-induced bicytopenia because its early detection can decrease the severity of these side effects.

References

1. Gedar Totuk OM, Yukselen A. Acute allergic reaction caused by topical azithromycin eye drops: A report of two cases. Saudi J Ophthalmol. 2019;33(2):180-2.
2. Hansen MP, Scott AM, McCullough A, et al. Adverse events in people taking macrolide antibiotics versus placebo for any indication. The Cochrane Database Syst Rev. 2019;1:CD011825.
3. Astale T, Sata E, Zerihun M, et al. Self-Reported Side Effects following Mass Administration of Azithromycin to Eliminate Trachoma in Amhara, Ethiopia: Results from a Region-Wide Population-Based Survey. Am J Trop Med Hyg. 2019;100(3):696-9.
4. Karimi S, Nikkhah H, Fekri S. Ocular Toxoplasmosis Presenting as Subretinal Macrocyst. J Ophtalmic Vis Res. 2019;14(2):223-5.
5. Feliciano-Alfonso JE, Vargas-Villanueva A, Marin MA, et al. Antibiotic treatment for ocular toxoplasmosis: a systematic review and meta-analysis: study protocol. Syst Rev. 2019;8(1):146.
6. Bosch-Driessen LH, Verbraak FD, Suttorp-Schulten MS, et al. A prospective, randomized trial of pyrimethamine and azithromycin vs pyrimethamine and sulfadiazine for the treatment of ocular toxoplasmosis. Am J Ophthalmol. 2002;134(1):34-40.
7. Lashay A, Mirshahi A, Parandin N, et al. A prospective randomized trial of azithromycin versus trimethoprim/sulfamethoxazole in treatment of toxoplasmic retinochoroiditis. J Curr Ophthalmol. 2017;29(2):120-5.
8. Hopkins S. Clinical toleration and safety of azithromycin. Am J Med. 1991;91(3a):40s-5s.
9. Treadway G, Pontani D. Paediatric safety of azithromycin: worldwide experience. J Antimicrob Chemother. 1996;37 Suppl C:143-9.
10. Higa F, Saito A. Clinical safety of azithromycin. Jpn J Antibiot. 2000;53 Suppl B:125-35.
11. Kajiguchi T, Ohno T. Azithromycin-related agranulocytosis in an elderly man with acute otitis media. Intern Med. 2009;48(12):1089-91.
12. Foulds G, Shepard RM, Johnson RB. The pharmacokinetics of azithromycin in human serum and tissues. J Antimicrob Chemother. 1990;25 Suppl A:73-82.
13. Jaruratanasirikul S, Hortiwakul R, Tantisarasart T, Phuenpathom N, Tussanasunthornwong S. Distribution of azithromycin into brain tissue, cerebrospinal fluid, and aqueous humor of the eye. Antimicrob Agents Chemother. 1996;40(3):825-6.
14. Huskinson-Mark J, Araujo FG, Remington JS. Evaluation of the effect of drugs on the cyst form of Toxoplasma gondii. J Infect Dis. 1991;164(1):170-1.
Published
2020-02-03
How to Cite
1.
Hammami F, Fourati S, Koubaa M, Smaoui F, Rekik K, Marrakchi C, Ben Jemaa M. Azithromycin-Related Bicytopenia: An Exceptional Adverse Effect. J Pharm Care. 7(4):118-119.
Section
Case Report(s)