title: Hypoprothrombinaemia and bleeding during administration of cefamandole and cefoperazone. Report of three cases.
abstract: Deficiency of vitamin K-dependent coagulation factors caused by the cephalosporin derivatives cefamandole, cefoperazone and moxalactam has been recently recognized. It has been suggested that this adverse reaction may result from vitamin K deficiency caused by eradication of the vitamin K producing intestinal bacteria or inhibition of action of vitamin K 1. Three patients are described in whom hypoprothrombinaemic bleeding developed during administration of cefamandole or cefoperazone. All patients were elderly, had previous malnutrition or had been on parenteral nutrition without vitamin K supplementation. One patient had renal failure. Bleeding manifested 5-14 days after the start of antibiotic treatment. Other causes of the bleeding were excluded. One case was fatal and in 2 cases the coagulopathy was corrected by administration of vitamin K 1 or fresh frozen plasma and cessation of the antibiotic. We recommend prophylactic administration of vitamin K 1 during cefamandole or cefoperazone treatment to patients at risk, i.e. elderly malnourished patients especially those with renal failure or on parenteral nutrition.
mesh_terms: D000368:Aged; D001778:Blood Coagulation Disorders / Q000139:chemically induced* / Q000517:prevention & control; D002435:Cefamandole / Q000009:adverse effects*; D002438:Cefoperazone / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007020:Hypoprothrombinemias / Q000139:chemically induced* / Q000517:prevention & control; D008297:Male; D012306:Risk; D014812:Vitamin K / Q000627:therapeutic use
chemical_list: D014812:Vitamin K; D002435:Cefamandole; D002438:Cefoperazone