Piperacillin/tazobactam-induced bone marrow suppression during pregnancy: A case report

Introduction: Piperacillin/tazobactam is a bacteriolytic combined antibiotic that contains the extended-spectrum penicillin antibiotic, piperacillin, and the β-lactamase inhibitor, tazobactam. The piperacillin/tazobactam acts against several gram-positive and -negative bacteria. Some of the most common adverse reactions of piperacillin/tazobactam are diarrhea (7–11%) and fever (2–5%). The least common reported adverse reactions of piperacillin/tazobactam are hematological reactions ( < 1%), which include leukopenia, neutropenia, and/or thrombocytopenia. The use of piperacillin/tazobactam during pregnancy is considered to be moderately safe (pregnancy category B) for the human embryo-fetus. We report a case of piperacillin/tazobactam-induced fever, leukopenia, neutropenia, and thrombocytopenia during pregnancy in Qatar. Case description: A 33-year-old pregnant patient (22 weeks of gestation, gravid 6 para 3 plus 2 miscarriages) was admitted to Women's Hospital, Doha, Qatar and was treated for preterm premature rupture of membrane (PPROM) with erythromycin for 10 days. Afterwards, she was treated with piperacillin/tazobactam for asymptomatic urinary tract infection (Pseudomonas species). After 15 days of piperacillin/tazobactam treatment, she developed fever, leukopenia, neutropenia, and thrombocytopenia. These adverse reactions were reversed after the discontinuation of use of piperacillin/tazobactam combination. Discussion: In Qatar and worldwide, there are no reported cases regarding any form of bone marrow suppression or fever induced by piperacillin/tazobactam during pregnancy. Using the Naranjo Adverse Drug Reaction Probability scales, the score was found to be eight representing a probable adverse drug reaction. Conclusion: We report a case of probable fever, leukopenia, neutropenia, and thrombocytopenia induced by piperacillin/tazobactam in a pregnant woman. It is important for healthcare professionals to be aware of the possibility of these serious adverse drug reactions while using this antibiotic combination. All patients must be monitored carefully while being treated with this combination, especially pregnant women.