Neutropenia and infection

Ok so I've been on cephalaxin for 10 days, went off for 1 day, and now infection is back so skin doctor wants me to do another 10 days.  Just got blood test results, neutophils are around 600, so doc doesn't want me to take shot until I have more blood work done.  I am ten weeks into treatment, and I don't understand why neupogen isn't an option. I go for my twelve week test in two weeks and am already nervous about that.  I am wondering if the antibiotics or infection (doc said it was bacterial) have anything to do with low wbc/neutophil count.  From what I understand, I thought wbc goes up with infections not down, although I guess maybe its different for people on tx.  I am so nervous, I really want to go through with treatment, and really don't want to miss a dose, and am a bit confused as to why neupogen hasn't been mentioned (although I dunno maybe another blood test would change that)...help!!!

[Trinity4]

What is your ANC?

[a823]

That is exactly why he doesn't want to put you on it. You are supposed to have a higher WBC,but your body isn't responding the way it should. Your kupper cells are not responding the way they need to and your helper T-4 cells are not either, if your WBC's are low.

If you take something so strong, while you are down, you may land in the hospital.

[Trinity4]

If you're referring to taking Neupogen a823, you are incorrect.  My question to cjsam was based on ANC, not neuts.  If you are talking about taking the interferon than dose reduction or adding the helper drug Neupogen but only if the ANC dictates it.  

You may want to do some research on this topic.

Trinity

[a823]

I was referring to why the doc doesn't want to give the shot, but wants treatment of anti.

[cjsam]

Actually, my skin doctor was the one who prescribed the antibiotics, my GI doctor did not.  I just left a message at the office that I was prescribed antibiotics.  I am unsure of my ANC, I am going to get my results tomorrow, and I will post once I get them; all I know is the office called me to tell me my neuts were in th 600's and my wbc's were low and further testing was needed before i take my shot.  Now as far as the antibiotics, can that reduce the WBC's?  I've heard mixed results on that.

[newleaf09]

Low neutrophil count allows infection to move in and develop.  Antibiotics don't alter the number of neutrophils, just kills the bacteria causing the infection.  Both items need to be addressed: get rid of the current infection; raise the neutrophil count so it can do it's job and fight off bacteria before they cause another infection.  No point drenching you with antibiotics if the neutrophil count can be brought up enough to prevent the infections from getting started in the first place

[JennyPenny2009]

With an ANC of 600, you have plenty of neuts to fight infection. Docs who are not hematologists tend to worry about this but the hemo docs know hematology. With neutrophils of 600 neupogen is probably not needed yet. Of course it is the interferon that is lowering your ANC. Mine actually dropped to zero and that was very scary. That is the point where the hematoklogist told me that all I really needed were 100 "good ones" to fight my upper respiratory infection. Hope yours come up soon.

[Bill1954]

I do think that your ANC warrants extra caution regarding infectious agents though; try to stay out of emergency rooms, etc. I knew a gal locally here that worked in hospital housekeeping; her doctor signed her disability papers very early due to her low neuts and her occupational exposure.

People that work with public contact might be more prone to illness with lowered neutrofils like you have--

Bill

[nygirl7]

Yes I agree your neuts are strong enough not to warrant neupogen right away.  They go up and down on their own so it's worth keeping a diligent eye on it but not over react.

Make sure you wash your hands often. And even things like your phone at work - don't let other people use it or grab a pen off your desk or things like that. It sounds crazy but pens (something I never thought of) go hand to hand all day long and are loaded with germs.  Washing up as often as you can will help you.  Helped me greatly.

[mikesimon]

Aliment Pharmacol Ther. 2009 May 1;29(9):1000-10. Epub 2009 Feb 7.
Bacterial infection and neutropenia during peginterferon plus ribavirin combination therapy in patients with chronic hepatitis C with and without baseline neutropenia in clinical practice.

"...CONCLUSIONS: Bacterial infection during peginterferon-based therapy for CHC was associated with comorbidity of cirrhosis, but not with neutropenia, whether at baseline or during treatment. Neutropenic CHC patients might be treated safely with close monitoring."

Infection. 2008 Jun;36(3):250-5. Epub 2008 May 3.
Incidence of neutropenia and infections during combination treatment of chronic hepatitis C with pegylated interferon alfa-2a or alfa-2b plus ribavirin.

"...CONCLUSIONS: During the treatment with pegylated interferons and ribavirin, we did not find a correlation between neutropenia and infections. This result provides a support for the notion that current guidelines for pegylated interferons dose reduction in the treatment of chronic hepatitis C for hematologic toxicity could be overly strict."

[jusjames]

thats very interesting indeed mike!