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TITLE:

THE ROLE OF LONG TERM ANTIMICROBIAL THERAPY IN THE DEVELOPMENT OF ACQUIRED APLASTIC ANEMIA

AUTHORS:

Muhammad Asif Syed, Aneela Atta Ur Rahman, Muhammad Ilyas Siddiqui, Ashique Ali Arain

ABSTRACT:

Background: Aplastic anemia (AA) is a rare hematological disorder and it carries very poor prognosis associated with high mortality rate. It has been remains an important public health concern for Asian population as it affects 2-3 fold more as compare to other part of world. Exposures of specific drugs, chemicals and others have been connected with an AA etiology. We aimed to examine the association of antimicrobial drugs exposures with AA. Methods: We done a case-control study in Karachi, Pakistan. Cases were patients showed at least two blood lineages depressed on bone marrow biopsy. Controls were without hematological disorder selected from outpatient department. For each case four age-sex matched control were enrolled. Information associated to socio-demographics and exposure to antibiotics was collected through a questionnaire by in personal interview. We computed odds ratios (OR) and 95% confidence intervals (CI). Results: We identified 191 cases (median age 26, range 1-66 years) and 696 controls. Predominate were male 67% (n=131), most affected age group 16-30 years. When the cases were compared with the controls, positive associations with antimicrobial drugs with AA were observed (49.7% exposure rate in cases, 29.3% in control: OR 2.3, 95% CI 1.7-3.3: P value 0.00). No statistically significant association were found when each drug i.e. Trimethoprim/Sulfamethoxazole, chloramphenicol, tetracycline, beta-lactam and macrolides used in univariate analysis. Conclusion: No association identified with use of antibiotics. However OR 2.3 with use of antibiotics showed connection with AA. Key Words: Aplastic Anemia, antimicrobials, chronic use, exposure.

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