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Fibrosis quística y piperacilina tazobactam: reacciones adversas
Cystic Fibrosis and Piperacillin-tazobactam: Adverse Reactions
Layla Diab Cáceres
, María Celeste Marcos, Rosa María Girón Moreno
Corresponding author
Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España
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"gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003171?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615001040?idApp=UINPBA00003Z" "url" => "/03002896/0000005100000012/v2_201511280826/S0300289615001040/v2_201511280826/es/main.assets" ] "es" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Fibrosis quística y piperacilina tazobactam: reacciones adversas" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Sr. Director:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "664" "paginaFinal" => "665" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Layla Diab Cáceres, María Celeste Marcos, Rosa María Girón Moreno" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Layla" "apellidos" => "Diab Cáceres" "email" => array:1 [ 0 => "layladch@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María Celeste" "apellidos" => "Marcos" ] 2 => array:2 [ "nombre" => "Rosa María" "apellidos" => "Girón Moreno" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cystic Fibrosis and Piperacillin-tazobactam: Adverse Reactions" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Los pacientes con fibrosis quística (FQ), debido a que padecen infecciones pulmonares crónicas y frecuentes exacerbaciones por distintas bacterias, <span class="elsevierStyleItalic">Pseudomonas aeruginosa (P. aeruginosa), Achromobacter xylosoxidan</span>, suelen precisar múltiples ciclos de tratamientos antibióticos entre los que se emplea piperacilina/tazobactam. En trabajos previos se ha descrito un aumento de la incidencia de efectos adversos sobre la médula ósea por este fármaco, recomendándose tomar precauciones en su uso<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Presentamos los casos de 2 pacientes con FQ, con fiebre y mielotoxicidad secundaria al tratamiento con piperacilina/tazobactam frente a la infección por <span class="elsevierStyleItalic">P. aeruginosa</span>, por lo que hubo que sustituir el tratamiento antibiótico.</p><p id="par0015" class="elsevierStylePara elsevierViewall">El primer paciente es un varón de 20 años con FQ genotipo F508del/F508, colonizado por <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina y <span class="elsevierStyleItalic">P. aeruginosa.</span> Ingresó por cuadro de exacerbación respiratoria con aumento de tos, expectoración verdosa, pérdida de peso y deterioro de función pulmonar, capacidad vital forzada (FVC): 2.950<span class="elsevierStyleHsp" style=""></span>ml (53%), volumen espiratorio en el primer segundo (FEV<span class="elsevierStyleInf">1</span>): 1.885<span class="elsevierStyleHsp" style=""></span>ml (42%) y FEV<span class="elsevierStyleInf">1</span>/FVC: 63,90. Se instauró tratamiento con piperacilina/tazobactam 4/0,5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h intravenosa (iv) y tobramicina 400<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h, siendo dado de alta a los 10 días para completar tratamiento domiciliario. Reingresa 7 días después por fiebre, mialgias y epigastralgia, detectándose anemia (Hb<span class="elsevierStyleHsp" style=""></span>11,3<span class="elsevierStyleHsp" style=""></span>g/dl) y leucopenia (2.940/mm<span class="elsevierStyleSup">3</span>) con frotis sanguíneo normal. La analítica mejoró tras suspender piperacilina/tazobactam que se sustituyó por ceftazidima, manteniendo el aminoglucósido.</p><p id="par0020" class="elsevierStylePara elsevierViewall">El segundo paciente es un varón de 23 años con FQ genotipo F508del/otra desconocida que presentaba los siguientes valores, FVC 2.950<span class="elsevierStyleHsp" style=""></span>ml (60%), FEV<span class="elsevierStyleInf">1</span>: 1.670<span class="elsevierStyleHsp" style=""></span>ml (42%) y FEV<span class="elsevierStyleInf">1</span>/FVC (56,56%) y padecía una infección bronquial crónica por <span class="elsevierStyleItalic">P. aeruginosa.</span> Se inició tratamiento con piperacilina/tazobactam 4/0,5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h y tobramicina 400<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h por síntomas de infección respiratoria y deterioro funcional. El día 17.° de tratamiento presentó fiebre (39,5<span class="elsevierStyleHsp" style=""></span>°C) sin otros síntomas acompañantes, en la analítica se objetivó anemia (Hb 12,5<span class="elsevierStyleHsp" style=""></span>g/dl), trombocitopenia (96.000/mm<span class="elsevierStyleSup">3</span>) (<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>), alteración de la coagulación (actividad de la protrombina 56% y tiempo de cefalina 41,6<span class="elsevierStyleHsp" style=""></span>s) y afectación hepática (GOT 170<span class="elsevierStyleHsp" style=""></span>U/l, GPT 51<span class="elsevierStyleHsp" style=""></span>U/l, GGT 24<span class="elsevierStyleHsp" style=""></span>U/l y LDH 1.462<span class="elsevierStyleHsp" style=""></span>U/l). Se sustituyó piperacilina/tazobactam por levofloxacino. El 4.° día posterior al ingreso se normalizaron las cifras de plaquetas (165.000/mm<span class="elsevierStyleSup">3</span>), la coagulación (actividad de protrombina 102% y tiempo de cefalina 29,6<span class="elsevierStyleHsp" style=""></span>s) y la función hepática (GOT 18<span class="elsevierStyleHsp" style=""></span>U/L, GPT 27<span class="elsevierStyleHsp" style=""></span>U/l, GGT 19<span class="elsevierStyleHsp" style=""></span>U/l, LDH 285<span class="elsevierStyleHsp" style=""></span>U/l).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Existen diversos casos en la literatura que reflejan los efectos adversos del tratamiento con piperacilina/tazobactam en pacientes con FQ, en los que, por razones aún no aclaradas, impresionan ser más frecuentes que en la población general<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a>. Se consideran factores de riesgo una elevada dosis acumulativa del antibiótico en un corto período de tiempo y los tratamientos prolongados (más de 10 días)<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a>. Se ha descrito anemia hemolítica inducida por haptenos<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> con buena respuesta al tratamiento con inmunoglobulina iv<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a>. También leucopenia, trombocitopenia, fiebre y reacciones de hipersensibilidad que van desde prurito y <span class="elsevierStyleItalic">rash</span> cutáneo hasta anafilaxia<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>. Las alteraciones de la coagulación y la hepatotoxicidad no han sido recogidas.</p><p id="par0030" class="elsevierStylePara elsevierViewall">En nuestra experiencia existe un aumento de efectos adversos por piperacilina/tazobactam en estos pacientes por lo que ha de usarse con precaución. En nuestro caso se empleó en un perfil de paciente con FQ «exacerbador frecuente» (precisa ≥<span class="elsevierStyleHsp" style=""></span>2 tratamientos antibióticos iv al año)<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> con intención de mejorar los resultados obtenidos con las combinaciones antibióticas previas. Concluimos que este fármaco ha de considerarse en segunda línea y no es recomendable usarlo en un periodo superior a 14 días o emplear dosis elevadas, aunque sean en un periodo corto de tiempo.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0035" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ningún conflicto de intereses.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicto de intereses" ] 1 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Tabla 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">iv: intravenosa; M: mujer; NR: No referido; PTZ: piperacilina/tazobactam; V: varón.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Referencia \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Año \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N.° de pacientes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad/Sexo \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Día de inicio sintomatología \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Efectos adversos (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Reichardt P.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1996-1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dosis acumulada en 14 días 4,9<span class="elsevierStyleHsp" style=""></span>g/kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fiebre, malestar generaly cefaleaLeucopenia y trombocitopenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Discontinuación PTZ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bandara M.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4,5<span class="elsevierStyleHsp" style=""></span>g iv cada 6<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anemia hemolítica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Transfusión, esteroides, inmunoglobulina iv, discontinuación PTZ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Zanetti R.C.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anemia hemolítica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Transfusión, inmunoglobulina iv, discontinuación PTZ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Marik P.E.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24/V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anemia hemolítica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Transfusión, esteroides, inmunoglobulina iv, discontinuación PTZ \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab951869.png" ] ] ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reacciones adversas por piperacilina/tazobactam en Fibrosis quística</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukocytopenia, thrombocytopenia and fever related to piperacillin/tazobactam treatment. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 2 | 16 |
| 2024 October | 102 | 25 | 127 |
| 2024 September | 86 | 15 | 101 |
| 2024 August | 96 | 38 | 134 |
| 2024 July | 84 | 25 | 109 |
| 2024 June | 109 | 30 | 139 |
| 2024 May | 108 | 28 | 136 |
| 2024 April | 82 | 19 | 101 |
| 2024 March | 88 | 21 | 109 |
| 2024 February | 53 | 36 | 89 |
| 2023 June | 1 | 0 | 1 |
| 2023 March | 13 | 2 | 15 |
| 2023 February | 80 | 20 | 100 |
| 2023 January | 58 | 24 | 82 |
| 2022 December | 64 | 39 | 103 |
| 2022 November | 53 | 25 | 78 |
| 2022 October | 50 | 39 | 89 |
| 2022 September | 56 | 26 | 82 |
| 2022 August | 70 | 42 | 112 |
| 2022 July | 86 | 50 | 136 |
| 2022 June | 98 | 34 | 132 |
| 2022 May | 73 | 24 | 97 |
| 2022 April | 92 | 44 | 136 |
| 2022 March | 69 | 36 | 105 |
| 2022 February | 78 | 25 | 103 |
| 2022 January | 75 | 34 | 109 |
| 2021 December | 84 | 57 | 141 |
| 2021 November | 75 | 60 | 135 |
| 2021 October | 82 | 42 | 124 |
| 2021 September | 61 | 56 | 117 |
| 2021 August | 54 | 39 | 93 |
| 2021 July | 73 | 37 | 110 |
| 2021 June | 79 | 34 | 113 |
| 2021 May | 110 | 33 | 143 |
| 2021 April | 184 | 77 | 261 |
| 2021 March | 142 | 33 | 175 |
| 2021 February | 128 | 34 | 162 |
| 2021 January | 84 | 24 | 108 |
| 2020 December | 78 | 21 | 99 |
| 2020 November | 78 | 27 | 105 |
| 2020 October | 85 | 23 | 108 |
| 2020 September | 56 | 20 | 76 |
| 2020 August | 62 | 16 | 78 |
| 2020 July | 45 | 24 | 69 |
| 2020 June | 52 | 17 | 69 |
| 2020 May | 80 | 18 | 98 |
| 2020 April | 49 | 28 | 77 |
| 2020 March | 75 | 29 | 104 |
| 2020 February | 70 | 21 | 91 |
| 2020 January | 71 | 25 | 96 |
| 2019 December | 68 | 17 | 85 |
| 2019 November | 92 | 25 | 117 |
| 2019 October | 82 | 30 | 112 |
| 2019 September | 90 | 21 | 111 |
| 2019 August | 70 | 18 | 88 |
| 2019 July | 72 | 18 | 90 |
| 2019 June | 59 | 12 | 71 |
| 2019 May | 81 | 36 | 117 |
| 2019 April | 91 | 48 | 139 |
| 2019 March | 57 | 37 | 94 |
| 2019 February | 40 | 28 | 68 |
| 2019 January | 39 | 23 | 62 |
| 2018 December | 50 | 30 | 80 |
| 2018 November | 81 | 16 | 97 |
| 2018 October | 114 | 17 | 131 |
| 2018 September | 76 | 10 | 86 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 15 | 1 | 16 |
| 2018 April | 69 | 6 | 75 |
| 2018 March | 66 | 6 | 72 |
| 2018 February | 61 | 12 | 73 |
| 2018 January | 99 | 10 | 109 |
| 2017 December | 51 | 9 | 60 |
| 2017 November | 50 | 9 | 59 |
| 2017 October | 54 | 8 | 62 |
| 2017 September | 24 | 9 | 33 |
| 2017 August | 42 | 11 | 53 |
| 2017 July | 27 | 11 | 38 |
| 2017 June | 47 | 30 | 77 |
| 2017 May | 40 | 16 | 56 |
| 2017 April | 34 | 11 | 45 |
| 2017 March | 32 | 39 | 71 |
| 2017 February | 18 | 2 | 20 |
| 2017 January | 18 | 8 | 26 |
| 2016 December | 15 | 12 | 27 |
| 2016 November | 44 | 21 | 65 |
| 2016 October | 48 | 37 | 85 |
| 2016 September | 37 | 19 | 56 |
| 2016 August | 32 | 8 | 40 |
| 2016 July | 51 | 12 | 63 |
| 2016 June | 59 | 22 | 81 |
| 2016 May | 51 | 15 | 66 |
| 2016 April | 50 | 2 | 52 |
| 2016 March | 42 | 0 | 42 |
| 2016 February | 3 | 2 | 5 |
| 2016 January | 3 | 1 | 4 |
| 2015 December | 20 | 9 | 29 |
| 2015 November | 17 | 0 | 17 |
| 2015 October | 1 | 0 | 1 |
Show all
