International Journal of Infectious Diseases and Therapy

Submit a Manuscript

Publishing with us to make your research visible to the widest possible audience.

Propose a Special Issue

Building a community of authors and readers to discuss the latest research and develop new ideas.

Ciprofloxacin-Induced Thrombocytopenia: A Case Report and Literature Review

Background: Drug induced thrombocytopenia is associated with several usual drugs. It usually presents with stunning, chills, fever, nausea and vomiting followed by the occurrence of petechial hemorrhages and bruising. Fluoroquinolones which are a widely used antibiotics are not recognized to be common offenders. Ciprofloxacin is generally considered a safe and well-tolerated drug. It has a large spectrum and it is one of the most widely prescribed antibiotics in a broad range of infections. Purpose: Only a few cases of fluoroquinolone-induced thrombocytopenia have been reported thus this side effect is largely unknown by clinicians. Case: We report the case of a 55 year old women with a bilateral percutaneous nephrostomy secondary to a radiation-induced cystitis. She was known for chronic kidney disease KDIGO IIIb and arterial hypertension. She suffered severe thrombocytopenia on three different occasions while treated by ciprofloxacin for urinary infections. She remained asymptomatic although her platelet count dropped as low as 6×103/µL. Each time, her platelet count recovered within a few days after ciprofloxacin interruption. Conclusion: Clinicians should be aware of the possible relationship between thrombocytopenia and ciprofloxacin. In depth work-up should be carried out to assess relationship between a newly introduced drug and a serious clinical or biological side effect.

Ciprofloxacin, Thrombocytopenia, Drug Induced Toxicity, Antibiotic Toxicity, Hematologic Toxicity

APA Style

Alexis Orman, Mohamed Tayeb Salaouatchi, Anne Demulder, Juliette Coryn, Victor Fernando Calderon Plazarte, et al. (2023). Ciprofloxacin-Induced Thrombocytopenia: A Case Report and Literature Review. International Journal of Infectious Diseases and Therapy, 8(3), 122-126. https://doi.org/10.11648/j.ijidt.20230803.17

ACS Style

Alexis Orman; Mohamed Tayeb Salaouatchi; Anne Demulder; Juliette Coryn; Victor Fernando Calderon Plazarte, et al. Ciprofloxacin-Induced Thrombocytopenia: A Case Report and Literature Review. Int. J. Infect. Dis. Ther. 2023, 8(3), 122-126. doi: 10.11648/j.ijidt.20230803.17

AMA Style

Alexis Orman, Mohamed Tayeb Salaouatchi, Anne Demulder, Juliette Coryn, Victor Fernando Calderon Plazarte, et al. Ciprofloxacin-Induced Thrombocytopenia: A Case Report and Literature Review. Int J Infect Dis Ther. 2023;8(3):122-126. doi: 10.11648/j.ijidt.20230803.17

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Starr JA, Ragucci KR. Thrombocytopenia associated with intravenous ciprofloxacin. Pharmacotherapy. 2005 Jul; 25 (7): 1030-4. doi: 10.1592/phco.2005.25.7.1030. PMID: 16006282.
2. Sim DW, Yu JE, Jeong J, Koh YI. Ciprofloxacin-induced immune-mediated thrombocytopenia: No cross-reactivity with gemifloxacin. J Clin Pharm Ther. 2018 Feb; 43 (1): 134-136. doi: 10.1111/jcpt.12596. Epub 2017 Aug 8. PMID: 28791716.
3. Aster RH, Bougie DW. Drug-induced immune thrombo- cytopenia. N Eng J Med 2007; 357: 580–587.
4. Cheah CY, De Keulenaer B, Leahy MF. Fluoroquinolone-induced immune thrombocytopenia: a report and review. Intern Med J. 2009 Sep; 39 (9): 619-23. doi: 10.1111/j.1445-5994.2009.01996.x. PMID: 19769684.
5. Williamson DR, Lesur O, Tetrault JP, Pilon D. Drug-induced thrombo-cytopenia in the critically ill: a case-control study. Ann Pharmacother. 2014; 48: 697-704.
6. Hashmi HR, Diaz-Fuentes G, Jadhav P, Khaja M. Ciprofloxacin-Induced Thrombotic Thrombocytopenic Purpura: A Case of Successful Treatment and Review of the Literature. Case Rep Crit Care. 2015; 2015: 143832. doi: 10.1155/2015/143832. Epub 2015 Oct 26. PMID: 26587293; PMCID: PMC4637463.
7. Sharma PC, Jain A, Jain S, Pahwa R, Yar MS. Ciprofloxacin: review on developments in synthetic, analytical, and medicinal aspects. J Enzyme Inhib Med Chem. 2010 Aug; 25 (4): 577-89. doi: 10.3109/14756360903373350. PMID: 20235755.
8. Dutta TK, Badhe BA. Ciprofloxacin-induced bone marrow depression. Postgrad Med J. 1999 Sep; 75 (887): 571-3. doi: 10.1136/pgmj.75.887.571. PMID: 10616701; PMCID: PMC1741342.
9. Allan DS, Thompson CM, Barr RM, Clark WF, Chin-Yee IH. Ciprofloxacin-associated hemolytic-uremic syndrome. Ann Pharmacother. 2002 Jun; 36 (6): 1000-2. doi: 10.1345/aph.1A350. PMID: 12022900.
10. Davis R, Markham A, Balfour JA. Ciprofloxacin - an updated review of its pharmacology, therapeutic eYcacy and tolerability. Dr ugs 1996; 51: 1019–74.
11. Jick SS, Jick H, Dean AD. A follow-up safety study of ciprofloxacin users. Pharmacotherapy. 1993 Sep-Oct; 13 (5): 461-4. PMID: 8247912.
12. Santucci R, Bouayad-Agha K, Maloisel F, Couturier F. Thrombocytopénie induite par la ciprofloxacine [Ciprofloxacin-induced thrombopenia]. Med Mal Infect. 2012 Apr; 42 (4): 175-6. French. doi: 10.1016/j.medmal.2012.02.008. Epub 2012 Apr 3. PMID: 22475418.
13. Ziemen M, Shah PM, Breddin K. Haemostasis during treatment with ciprofloxacin. Infection 1988; 16: 65-68.
14. Reutter HI). Investigations on the effects of ciprofloxacin on epinephorine and collagen-induced-platelet aggregation in-vitro. Chemioterapia 1987; 6: 322-324.
15. Teh C, McKendrick M. Ciprofloxacin-induced thrombocytopenia. J Infect. 1993 Sep; 27 (2): 213-5. doi: 10.1016/0163-4453(93)95106-s. PMID: 8228311.
16. Erdemli Ö, Timuroğlu A, Oral İ, Çekmen N. Ciprofloxacin-induced severe thrombocytopenia. Kaohsiung J Med Sci. 2015 Feb; 31 (2): 110-1. doi: 10.1016/j.kjms.2014.08.001. Epub 2014 Sep 19. PMID: 25645991.
17. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981 Aug; 30 (2): 239-45. doi: 10.1038/clpt.1981.154. PMID: 7249508.
18. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012–. Adverse Drug Reaction Probability Scale (Naranjo) in Drug Induced Liver Injury. 2019 May 4. PMID: 31689026.
19. George JN, Raskob GE, Shah SR, et al. Drug-induced thrombocytopenia: a systematic review of published case reports. Ann Intern Med 1998; 129: 886–90.
20. Zondor SD, George JN, Medina PJ. Treatment of drug-induced thrombocytopenia. Expert Opin Drug Saf 2002; 1 (2): 173–80.