Risk of Neutropenia with the Use of Ceftaroline: A Review

Objective: Ceftaroline is a fifth-generation cephalosporin with activity against methicillin-resistant Staphylococcus aureus (MRSA), which is a clinically distinct feature for a member of this class. Cephalosporins have previously been associated with neutropenia, a serious hematologic condition with an absolute neutrophil count (ANC) falling below 1500-1800 cells/µL. Since its FDA approval in 2010, ceftaroline has been associated with neutropenia in several studies. In this review, our aim is to examine these reports and evaluate their findings. Data sources: A systematic search was conducted using PubMED, Embase, and Web of Science databases. Keywords utilized in the search were “ceftaroline, or Teflaro, or Zinforo” and “neutropenia.” Study selection: Case reports, case series, observational, and experimental studies in the English language of human participants were included. For inclusion, neutropenia was defined as an ANC of no more than 1800 cells/µL. Studies reporting concurrent exposure to chemotherapy were excluded. Data extraction/synthesis: Search results produced eight published articles that underwent review by the authors. Two case studies and six observational studies highlighted a common theme and outcome: Extended use of ceftaroline with exposure greater than two consecutive weeks is associated with an increased risk of neutropenia. Conclusions: To our knowledge, this is the first review to explore the risk of neutropenia with ceftaroline use. Despite the limited amount of relevant published research, existing results suggest a potential association. Large well-designed observational studies are needed to delineate the impact and implications of this serious adverse event.