Ciprofloxacin屬於fluoroquinolone類抗感染劑，副作用多半輕微且可回復，最常被報告的為胃腸道的反應，至於血液方面的副作用則很少被提及。本文主要報告疑似短期使用口服ciprofloxacin所導致之白血球低下症。一位73歲男性病患，有高血壓、糖尿病及慢性呼吸道阻塞性肺病病史，因下背疼痛就診，診斷為L2壓迫性骨折。在住院治療期間，病人發生肺炎合併急性呼吸衰竭，轉入加護病房以piperacillin/tazobactam及gentamicin治療。病人在加護病房期間發生缺血性大腸炎，進行部分結腸切除術及膿瘍抽取，並以抗生素imipenem/cilastatin及vancomycin治療（切除部位之細菌組織培養結果為Klebsiella pneumoniae及enterococcus），之後體溫及生命徵象維持穩定的狀態，於治療一個月後停止所有抗生素的使用。病人於四日後突然高燒至38℃，於是經驗性使用口服ciprofloxacin，劑量為每12小時服用500mg。經過三天的治療後，血液中白血球的數目由7850/μl降至3890/μl，紅血球及血小板的數目亦有下降的情形。由於懷疑是ciprofloxacin所引起之骨髓抑制作用，因此停止使用ciprofloxacin，病人的白血球數目於停用三日後回升至6370/μl。Ciprofloxacin所引起之可逆性的白血球低下症發生率不高，但若是病人在使用ciprofloxacin後白血球有突然下降的情形時，應懷疑是此藥物所引起之副作用。
Ciprofloxacin is a fluoroquinolone antibacterial agent, its adverse reactions are usually mild and reversible, mostly involve the gastrointestinal system. Hematologic reactions associated with ciprofloxacin use have been reported rarely, this article describes an episode of leukopenia related to short term use of oral ciprofloxacin.
A 73 years old man, with hypertension, diabetes mellitus, and chronic obstructive pulmonary disease history went to emergency room due to low back pain, and admitted with a diagnosis of L2 compressive fracture. During admission, the patient developed pneumonia with acute respiratory failure, so he was transferred to intensive care unit and treated with piperacillin/tazobactam and gentamicin. He got ischemic colitis later, partial colestectomy and abcess drainage were performed, and imipenem/cilastatin and vancomycin were used because bowel culture showed Klebsiella pneumoniae and enterococcus. His vital signs remained stable afterward, and antibiotics were stopped after one month. Four days after stopping antibiotics, the patient got fever up to 38℃, and ciprofloxacin 500mg every 12 hours orally was started empirically. The leukocyte counts dropped from 7850/μl to 3890/μl after 3 days of ciprofloxacin therapy, because the physician presumed this reaction was drug related, ciprofloxacin was discontinued, and patient’s leukocyte counts rose to 6370/μl after 3 days.
Although the incidence of ciprofloxacin induced reversible leukopenia was low, this reaction should be suspected when leukocyte counts fall soon after starting ciprofloxacin.
