A case of vancomycin-associated neutropenia occurring during long-term outpatient therapy with vancomycin is described. Pharmacokinetic studies demonstrated that the patient's vancomycin serum levels were within an acceptable range during treatment. Eighteen other reported cases of vancomycin-associated leukopenia are discussed in brief. An immunologic mechanism has been proposed but a clear understanding is lacking. Patients receiving long-term vancomycin therapy should have their white blood cell counts periodically monitored.
NordenCW. Osteomyelitis. In: MandellGLDouglasRGJrBennettJE, eds. Principles and practice of infectious diseases. 2nd ed.New York: John Wiley & Sons, 1985: 704–11.
2.
GarrodLPLambertHPO'GradyF. Various anti-bacterial antibiotics. In: Antibiotic and chemotherapy. 5th ed.New York: Churchill Livingstone, 1981: 234–6.
3.
FeketyR. Vancomycin. Med Clin North Am1982; 66: 175–81.
4.
CookFVFarrarWEJr. Vancomycin revisited. Ann Intern Med1978; 88: 813–8.
5.
NewfieldPRoizenMF. Hazards of rapid administration of vancomycin. Ann Intern Med1979; 91: 581.
6.
AckermanBHBradsherRW. Vancomycin and red necks. Ann Intern Med1985; 102: 723–4.
7.
DangerfieldHGHewittWLMonzonOTKudinoffZBlackmanBFinegoldSM. Clinical use of vancomycin. Pediatr Clin North Am1961; 8: 1073–90.
FarberBFMoelleringRcJr. Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981. Antimicrob Agents Chemother1983; 23: 138–41.
17.
FarwellAPKendallLGJrVakilRDGlewRH. Delayed appearance of vancomycin-induced neutropenia in a patient with chronic renal failure. South Med J1984; 77: 664–5.
18.
MackettRLGuayDRP. Vancomycin-induced neutropenia. Can Med Assoc J1985; 132: 39–40.
19.
MordentiJRiesCBrooksGF. Vancomycin-induced neutropenia complicating bone marrow recovery in a patient with leukemia. Am J Med1986; 80: 333–5.
20.
WalkerRWHeatonA. Thrombocytopenia due to vancomycin (letter). Lancet1985; 1: 932.
21.
SchotlandMGGrumbachMM. Neutropenia in an infant secondary to hydrochlorothiazide therapy: with a review of hematologic reactions to “thiazide” drugs. Pediatrics1963; 33: 754–7.
22.
PrupasHMBrownD. Acute idiosyncratic reaction to hydrochlorothiazide ingestion. West J Med1983; 138: 101–2.
23.
GeraciJE. Vancomycin. Mayo Clin Proc1977; 52: 631–4.
