Vancomycin引起之嗜中性白血球減少

Vancomycin-Induced Neutropenia

嗜中性白血球減少最常見原因之一是由藥物引起，常見藥物為抗癌藥物引起骨隨抑制造成血球生合成減少；另為特異性藥物的不良反應造成血球減少，常見於抗生素之使用，而vancomycin 引發之嗜中性白血球減少通常與長期使用相關。根據全國藥物不良反應通報中心統計資料顯示，歷年來vancomycin一直是位居前十名高通報率的不良反應可疑藥品。此次報告為疑似長期使用vancomycin 引起之嗜中性白血球減少症不良反應之案例，希望藉此案例討論盼能提醒醫療人員於長時間使用vancomycin 期間應監測血球值之變化。

Vancomycin has been used for decades to treat serious gram-positive bacterial infections, particularly caused by methacillin-resistant Staphylococcus aureus. Adverse effects of vancomycin are rare, such as nephrotoxicity is preventable under therapeutic serum concentration monitoring and red man syndrome is related to infusion rate. Neutropenia is an uncommon adverse effect and is mainly associated with prolonged vancomycin therapy. This case reported a 49-year-old male administered vancomycin for necrotizing fasciitis. He developed neutropenia and vancomycin was replaced by teicoplanin on day 36 due to drug-induced neutropenia. The white blood cell and absolute neutrophil count were recovered to normal after 4 days discontinuation of vancomycin. Based on the Naranjo probability scale, the neutropenia was probably related with vancomycin therapy. Through this case report, we hope to remind it should have periodic assessment of white blood cell and neutrophil counts when patient is under long term vancomycin treatment and consider to discontinue vancomycin if neutropenia occurs.