1) Cephalosporins are a commonly used class of antibiotics --> what's not so commonly known is that some members of this drug class can cause major bleeding complications!
4 groups of cephalosporins have been implicated in this problem!
4 groups of cephalosporins have been implicated in this problem!
2) This is based on the different side chains attached to position 3 of the cephem nucleus!
The first and largest group is the NMTT (N-methylthiotetrazole) side chain containing group --> cefamandole, cefotetan, cefmatazole, moxalactam and cefoperazone!
The first and largest group is the NMTT (N-methylthiotetrazole) side chain containing group --> cefamandole, cefotetan, cefmatazole, moxalactam and cefoperazone!
3) Other groups include MTDT and HTT side chain containing cephalosporins as well as cefoxitin which doesn't have any side chains attached to the 3 position of the cephem nucleus!
4) Mechanism --> either direct inhibition of Vitamin K or inhibition of gut bacteria which produce Vit K (menadione or Vit K2)
The latter mechanism is more plausible because most bleeding occurred in malnourished patients!
The latter mechanism is more plausible because most bleeding occurred in malnourished patients!
5) Ceftriaxone has also been associated with some bleeding risk but it is believed to be much lower than the NMTT side chain containing cephalosporins!
6) This link between bleeding and cephalosporin use has been known since the 1980s but the evidence is conflicting and lacks hard evidence!
7) A recent study from South Korea in 2019 found the strongest evidence in favour of lab derived hemostatic abnormalities for cefoperazone, cefamandole and moxalactam!
But clinically significant bleeding problems was NOT STATISTICALLY SIGNIFICANT!
But clinically significant bleeding problems was NOT STATISTICALLY SIGNIFICANT!
8) It must be remembered that septic patients are very sick and may have many other causes for bleeding --> before we blame the antibiotics!!
But it is important to stay wary!
But it is important to stay wary!
1.ncbi.nlm.nih.gov/pmc/articles/P…
2.link.springer.com/article/10.100…
3.mdpi.com/1660-4601/16/2…
4.journals.sagepub.com/doi/abs/10.117…
Some of my resources especially source 3 (by Park et al in 2019) which is the most comprehensive!
2.link.springer.com/article/10.100…
3.mdpi.com/1660-4601/16/2…
4.journals.sagepub.com/doi/abs/10.117…
Some of my resources especially source 3 (by Park et al in 2019) which is the most comprehensive!
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