Potential for bleeding with the new beta-lactam antibiotics

F. R. Scattler, M. R. Weitekamp, J. O. Ballard

Research output: Contribution to journalReview articlepeer-review

82 Scopus citations


Several new beta-lactam antibiotics impair normal hemostasis. Hypoprothrombinemia has occurred frequently with cephalosporins that possess a methylthiotetrazole substitution (cefamandole, moxalactam, and cefoperazone). The incidence ranges from 4% to 68%, and the risk is greatest in debilitated patients with cancer, intra-abdominal infection, or renal failure. Impaired platelet function caused by perturbation of agonist receptors on the platelet surface has occurred primarily with beta-lactam antibiotics having an alpha-carboxyl substitution (moxalactam, carbenicillin, and ticarcillin). These antibiotics often cause the template bleeding time to be markedly prolonged (> 20 minutes). Acylureidopenicillins, which lack the alpha-carboxyl marker, impair platelet function less frequently and only modestly prolong the bleeding time. If serious hemorrhage occurs, hypoprothrombinemia associated with methylthiotetrazole-substituted cephalosporins should be treated with fresh frozen plasma. Likewise, dangerous bleeding due to impaired platelet aggretation requires treatment with platelet concentrates.

Original languageEnglish (US)
Pages (from-to)924-931
Number of pages8
JournalAnnals of internal medicine
Issue number6
StatePublished - 1986

All Science Journal Classification (ASJC) codes

  • Internal Medicine


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