PDF(Pubmed)
Abstract：
BACKGROUND Cefmetazole (CMZ), containing an N-methyl-tetrazole-thiol (NMTT) side chain, is a therapeutic option for diverticulitis in Japan. Cephems containing an NMTT, a methyl-thiadiazol, and a thiadiazolethiol side chain are known to induce coagulation disorders. CASE REPORT A 76-year-old woman developed hypoprothrombinemia after receiving oral levofloxacin (LVFX) 250 mg q24h for 2 days followed by intravenous CMZ 2 g q8h for sigmoid diverticulitis. On day 5 of CMZ administration (after 12 doses in total), black stool was observed. On the following day (after 14 doses), prothrombin time (PT) prolongation was noted; PT and international normalized ratio (INR) were 37.1 s and 2.47, respectively. We diagnosed the patient with hypoprothrombinemia because of vitamin K deficiency caused by markedly elevated protein levels induced by vitamin K absence or antagonist-II on day 6 of CMZ administration. Intravenous vitamin K administration and CMZ cessation rapidly restored PT and led to the disappearance of black stool. CONCLUSIONS The causes of vitamin K deficiency were considered to be an impaired vitamin K cycle due to CMZ and decreased vitamin K intake because of malnutrition. These findings are consistent with CMZ\'s reported adverse effects. Decreased vitamin K production due to alterations in the gut bacterial flora by LVFX and CMZ was also postulated as a cause. If a bleeding tendency is noted during diverticulitis treatment with NMTT-containing cephems, switching to intravenous quinolones or carbapenems is recommended. It remains unclear how this reaction can be avoided; however, prudent monitoring of bleeding signs and PT-INR is recommended.
摘要：
背景技术头孢美唑（CMZ），含有N-甲基-四唑-硫醇(NMTT)侧链，是日本憩室炎的治疗选择。含有NMTT的头孢，甲基噻二唑，和噻二唑硫醇侧链已知诱导凝血障碍。病例报告一名76岁女性在接受口服左氧氟沙星（LVFX）250mgq24h2天后，然后静脉注射CMZ2gq8h治疗乙状结肠憩室炎后出现低凝血酶原血症。在CMZ给药的第5天（总共12个剂量后），观察到黑色粪便。在第二天（14次剂量后），观察到凝血酶原时间(PT)延长;PT和国际标准化比率(INR)分别为37.1s和2.47.我们诊断该患者患有低凝血酶原血症，因为维生素K缺乏是由维生素K缺乏或拮抗剂II在CMZ给药第6天引起的蛋白质水平显着升高引起的。静脉注射维生素K和停止CMZ迅速恢复PT并导致黑便消失。结论维生素K缺乏的原因被认为是CMZ导致的维生素K循环受损和营养不良导致的维生素K摄入量减少。这些发现与CMZ报告的不良反应一致。由于LVFX和CMZ引起的肠道细菌菌群改变，维生素K的产生减少也被认为是原因。如果在使用含NMTT的头孢的憩室炎治疗期间发现出血倾向，建议改用静脉注射喹诺酮类药物或碳青霉烯类抗生素.目前尚不清楚如何避免这种反应；然而，建议谨慎监测出血体征和PT-INR.
