利福霉素注射液引起白细胞和中性粒细胞减少

Leucopenia and neutropenia caused by rifamycin injection

1例68岁女性患者,因患肺结核给予利福霉素0.5g,1次/d静脉滴注;异烟肼0.3g,1次/d口服;乙胺丁醇0.5g,3次/d口服。治疗前血常规正常:WBC4.91×109/L,N0.729。治疗12d后,WBC和N分别降至2.48×109/L和0.557。考虑白细胞减少可能与利福霉素有关,停用利福霉素。7d后,WBC和N恢复正常(分别为4.41×109/L和0.622)。再次静脉滴注利福霉素0.5g,1次/d,7d后,WBC和N分别下降至2.93×109/L和0.487。再次停用利福霉素,改为左氧氟沙星0.2g静脉滴注,2次/d,继续口服异烟肼和乙胺丁醇,10d后血常规恢复正常。

A 68-year-old woman with pulmonary tuberculosis was administered with IV rifamycin 0.5 g once daily, oral isoniazid 0.3 g once daily, and oral ethambutol 0.5 g thrice daily. Her routine blood tests were normal （ WBC count 4.91 × 109/L, neutrophils 0. 729） before therapy. After 12 days of therapy, her WBC count and neutrophils decreased to 2.48 x 109/L and 0.557, respectively. Leucopenia and neutropenia were considered to be possibly rifamyein-related, rifamycin was discontinued. Seven days later, the woman＇s WBC count and neutrophils returned to within normal limits （4.41 × 109/L and 0. 622, respectively）. IV rifamycin 0.5 g once daily was restarted. Seven days later, her WBC count and neutrophils decreased to 2.93 × 109/L and 0. 487, respectively. rifamycin was withdrawn again and switched to IV levofloxaein 0.2 g twice daily. Isoniazid and ethambutol were continued. Ten days later, her routine blood tests were normal.