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The objectives of this study were to describe the characteristics and natural history of beta‐lactam‐induced severe neutropaenia and to evaluate the risk of recurrences after another beta‐lactam readministration. Reports of pure agranulocytosis associated with a beta‐lactam exposure within the 10 days preceding the neutropaenia were extracted from the French Pharmacovigilance Database over the year 2010. Cases with another evident cause or more likely attributable to another drug were excluded. Data were analyzed for demographics, clinical and biological features, prognosis factors, granulocyte colony stimulating factors administration and outcome. Sixty‐two cases were included (median age: 65 years). The median duration of treatment before neutropaenia was 16 days. In 47% of cases, the diagnosis was made on a systematic blood cell count. The median neutrophil count at nadir was 0.125 × 109/L, and bone marrow examination evidenced features of neutrophilic maturation arrest or aplasia in 21 patients, hyperplasia of granulopoietic cells in three and normal findings in five. Three patients developed severe sepsis. All but one recovered a normal blood cell count within 2–56 days after beta‐lactam discontinuation. The last patient died from recurrent severe septic shock. No significant effect of granulocyte colony stimulating factor on the mean duration of haematological recovery was found. Among the 21 patients who later received another beta‐lactam, two experienced recurrence of the neutropaenia after receiving a beta‐lactam from another subfamily. Beta‐lactam‐induced agranulocytosis was usually observed after prolonged treatment, and severe complications are uncommon. In most patients, a subsequent treatment with another beta‐lactam was well tolerated. [ABSTRACT FROM AUTHOR]

Background: Perioperative anaphylaxis mainly involves neuromuscular blocking agents (NMBAs) with an IgE‐mediated mechanism. In France, this life‐threatening condition is reported by anesthetists and allergologists, and two safety alerts concerning suxamethonium were raised in 2011 and 2012. This led to start a national survey over the 2000‐2012 period which objectives were to provide a descriptive analysis, to estimate incidence rates, and to analyze the trends over this period. Methods: The French pharmacovigilance database was retrospectively queried for all the available NMBAs. Anaphylaxis cases with elevated tryptase and positive skin tests were qualified as "confirmed cases." Subgroup analysis compared atracurium and cisatracurium vs suxamethonium and rocuronium. Results: A total of 680 confirmed cases and 944 nonconfirmed cases were identified. Suxamethonium was the most implied NMBA (64%). Incidence rates (according to sales data) of suxamethonium and rocuronium were, respectively, 10‐ and 13‐folds higher than those of the others NMBAs, regardless the confirmed/nonconfirmed status. Cisatracurium incidence rates remained stable over the period, while suxamethonium and atracurium increased and rocuronium first decreased but re‐increased after 2006. Male patients were more frequent in the subgroup "atracurium‐cisatracurium" (P = .019), whereas obesity and emergency setting were more frequent in the subgroup "rocuronium‐suxamethonium." Shared characteristics were the poorly documented previous exposure to NMBA(s) and an insufficient adherence of patients to perform skin tests, showing the need to improve this procedure. Conclusion: Suxamethonium and rocuronium are markedly more involved in perioperative anaphylaxis than the other available NMBAs. Patients should be more informed about their perioperative anaphylaxis and its consequences. Perioperative anaphylaxis mainly involves neuromuscular blocking agents (NMBAs), and over the 2000‐2012 period, suxamethonium and rocuronium each had anaphylaxis incidence rates more than tenfold higher than atracurium and cisatracurium. Over this 13‐year period, the incidence rate of NMBA anaphylaxis showed a significant increase for suxamethonium and atracurium, whereas it remained stable for cisatracurium. Rocuronium displayed a 2‐period curve with a significant increase from 2005. Patients need to be more aware about the importance of allergological skin tests for ensuring safe further anesthetic procedures. [ABSTRACT FROM AUTHOR]

Résumé: Le syndrome de Sweet médicamenteux a été associé à des nombreuses molécules, dont les antibiotiques. Nous rapportons l’observation d’une patiente de 52ans ayant présenté une dermatose neutrophilique sévère après la prise d’amoxicilline-acide clavulanique pour angine non fébrile. L’association à l’amoxicilline-acide clavulanique n’a jamais été décrite. Une enquête médicamenteuse rigoureuse semble nécessaire devant une dermatose neutrophilique. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Tramadol is a weak opioid analgesic used as a step two analgesic, approved in France for the treatment of moderate to severe pain in adult patients. The most common side effects are gastrointestinal and neurologic. Hypoglycaemia is an almost unknown side effect. Case reports: We report two patients who presented with severe hypoglycaemia related to oral administration of tramadol in non diabetic patients. The underlying mechanisms of hypoglycaemia induced by tramadol are unclear. The only weak opioid analgesic drug reported to cause hypoglycaemia is propoxyphene, which has been widely used in France. The recent withdrawal of dextropropoxyphene in France might increase the prescriptions of tramadol and healthcare professionals should be aware of the risk of hypoglycaemia. Conclusion: The risk of hypoglycaemia should be added to the summary of product characteristics of tramadol. [Copyright &y& Elsevier]