Fatal hemolytic anemia induced by overdose of ceftizoxime sodium

Abstract

A 76-year-old man with bronchopneumonia received an IV infusion of ceftizoxime sodium 2 g twice daily. Before treatment, laboratory tests showed the following results: white blood cell count (WBC) 10.8×109/L, neutrophil 0.94, red blood cell count (RBC) 3.8×1012/L, hemoglobin (Hb) 121 g/L, total bilirubin (TBil) 12.6 μmol/L, indirect bilirubin (IBil) 8.7 μmol/L, serum creatinine (Scr) 151 μmol/L, blood urea nitrogen (BUN) 10.7 mmol/L, endogenous creatinine clearance rate 35 ml/min. On day 11, about 10 minutes after beginning infusion of the 22nd dosage of ceftizoxime, he developed low back pain with bladder distending pain and yellowish skin and sclera. Ceftizoxime sodium was withdrawn immediately. Urethral catheter drained soy sauce-colored urine 200 ml. Laboratory tests revealed the following results: WBC 15.7×109/L, neutrophil 0.68, RBC 1.1×1012/L, Hb 73 g/L, reticulocytes 0.023, TBil 83.8 μmol/L, IBil 61.8 μmol/L, Scr 127 μmol/L, BUN 11.9 mmol/L, D-dimer 9.8 mg/L, direct Coomb′s test positive, urine bilirubin (+ + ), occult blood (+ + ), 2-3 red blood cells per high power field. He received treatments such as hydration and urinary alkalinization, infusion of methylprednisolone, transfusion of washed red blood cells and etc. However, he had sustained low urine output, progressive jaundice, and finally died 8 hours later. Acute hemolytic anemia was considered to be induced by overdose of ceftizoxime sodium. Key words: Ceftizoxime; Anemia, hemolytic