Amoxicillin/clavulanic acid-associated severe neutropenia

A 72-year-old man presented with an abnormal blood count and was admitted. His history included hypertension and hyperlipidaemia with an old myocardial infarction and mild stroke; liver cirrhosis due to non-alcoholic steatohepatitis (NASH) with hypersplenism and oesophageal varices but no ascites, oedema or bleeding; and benign prostatic hypertrophy. His medications (unchanged for years) included furosemide, spironolactone, bisoprolol, rosuvastatin, alfuzosin and omeprazole. Two weeks prior, he was discharged from our department after left leg cellulitis and Streptococcus pyogenes bacteraemia responsive to parenteral clindamycin and ceftriaxone (later changed to penicillin G) continued for 10 days. On discharge, haemoglobin was 10.2 g/dL (mean corpuscular volume 96), white blood cells 3.4x103/µL (neutrophils 2.9x103/µL) and platelets 36x103/µL with C-reactive protein (CRP) 80 mg/dL. Five days before admission his primary physician prescribed amoxicillin 875 mg/clavulanic acid 125 mg (Augmentin) two times per day for ‘trace cellulitis’. On admission he was afebrile and stable with unremarkable examination, ECG and chest...
Source: Postgraduate Medical Journal - Category: General Medicine Authors: Tags: Adverse drug reactions Source Type: research