Cefepime: a rare cause of encephalopathy

McNally, Andrew; Pithie, Alan; Jardine, David L.

doi:10.1111/j.1445-5994.2012.02800.x

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…Many cases resolved spontaneously upon withdrawal of the medication, but fatal evolutions are also reported. Besides stopping cefepime, treatment generally has consisted of supportive measures and, occasionally, the administration of antiepileptic drugs (Table ) . A few cases have been treated with iHD (Table ) with a globally favorable outcome .…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

Mani

Kissling

Viceic

et al. 2014

Hemodialysis International

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Cefepime is a broad-spectrum cephalosporin indicated for in-hospital treatment of severe infections. Acute neurotoxicity, an increasingly recognized adverse effect of this drug in an overdose, predominantly affects patients with reduced renal function. Although dialytic approaches have been advocated to treat this condition, their role in this indication remains unclear. We report the case of an 88-year-old female patient with impaired renal function who developed life-threatening neurologic symptoms during cefepime therapy. She was treated with two intermittent 3-hour high-flux, high-efficiency hemodialysis sessions. Serial pre-, post-, and peridialytic (pre- and postfilter) serum cefepime concentrations were measured. Pharmacokinetic modeling showed that this dialytic strategy allowed for serum cefepime concentrations to return to the estimated nontoxic range 15 hours earlier than would have been the case without an intervention. The patient made a full clinical recovery over the next 48 hours. We conclude that at least 1 session of intermittent hemodialysis may shorten the time to return to the nontoxic range in severe clinically patent intoxication. It should be considered early in its clinical course pending chemical confirmation, even in frail elderly patients. Careful dosage adjustment and a high index of suspicion are essential in this population.

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Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

Mani

Kissling

Viceic

et al. 2014

Hemodialysis International

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“…Hence, it is worthwhile to raise awareness of the potential for cephalosporin neurotoxicity, especially in this vulnerable population, as it is a dose-dependent effect and rapid recognition of the offending agent would allow rapid recovery [ 12 ]. CNS side effects of cephalosporins have also been described in prior case reports that identified renal failure and prior central nervous disease as important risk factors for cephalosporin encephalopathy, often occurring with generalized triphasic waves on EEG [ 1 , 3 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The proposed pathophysiologic mechanisms for cephalosporin CNS effects include inhibition of γ -aminobutyric acid (GABA) release from nerve terminals, competitive inhibition of GABA binding to receptor sites, and increased excitatory amino acids [ 18 ]. The resulting clinical effects include confusion, hallucinations, cognitive disturbances, delirium, agitation, myoclonus, tremors, convulsions, nonconvulsive status epilepticus, and coma [ 1 , 19 ]. The temporal pattern of cephalosporin neurotoxicity is an average latency of 1–10 days after drug initiation with regression of all neurological symptoms within 2–7 days after drug cessation [ 12 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Ceftriaxone-Induced Acute Encephalopathy in a Peritoneal Dialysis Patient

Safadi

Mao

Dillon

2014

Case Reports in Nephrology

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Encephalopathy is a rare side effect of third and fourth generation cephalosporins. Renal failure and preexisting neurological disease are notable risk factors. Recognition is important as discontinuing the offending agent usually resolves symptoms. We present a case of acute encephalopathy in a patient with end stage renal disease (ESRD) treated with peritoneal dialysis (PD) who received intravenous ceftriaxone for peritonitis. This case illustrates the potential severe neurologic effects of cephalosporins, which are recommended by international guidelines as first-line antimicrobial therapy for spontaneous bacterial peritonitis.

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“…련(seizure) 등이 발생하였다는 보고들이 있으며, 이런 신경계 부작용은 신장기능이 떨어진 환자들에서 더 잘 발생한다고 보 고되었으나 1,2,[4][5][6][7][8][9][10][11] 정상 신장기능을 가진 환자에서도 뇌증이나 비경련 뇌전증지속상태(nonconvulsive status epilepticus)가 발생 할 수 있다고 보고되었다. [12][13][14] Cephalosporin 계열의 항생제에서 신경독성은 항생제가 가지고 있는 β-lactam ring 구조에 기인한다고 알려져 있 고 15 특히 경련이 발생하는 기전은 β-lactam ring 구조가 γ-aminobutyric acid (GABA) A-수용체에 대한 경쟁적 길항작 용(antagonism)을 갖기 때문에 GABA에 의한 억제 작용이 감 소하여 결국 pro-epileptogenic activity의 역할을 하기 때문으로 알려져 있다.…”

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Neurotoxicity by Cefepime: Case-Control Study

Kang¹,

Kim²

2014

J Neurocrit Care

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Background: Cefepime is a fourth-generation cephalosporin widely used for empiric treatment of severe infections. Neurotoxicity by cefepime have been reported due to γ-aminobutyric acid A receptor inhibition or other mechanisms. The aim of this study was to evaluate the risk factors for cefepime-induced neurotoxicity between group showing cefepime-induced neurotoxicity and group without neurotoxicity. Methods: From Jan 2005 to June 2010, a total of 2,461 patients (older than 20) who used cefepime were considered in this study. We compared patients who developed cefepime-induced neurotoxicity (patient group, n=21) to patients who had no cefepime-induced neurotoxicity (control group, n=31). We analyzed demographic, underlying diseases, and metabolic parameters before cefepime treatment and during cefepime treatment between the two groups. Statistical analysis was performed using SPSS 18 software. Results: Of the total 2461 patients, 21 (0.85%) were diagnosed with cefepime-induced neurotoxicity. Impaired glomerular filtration rate (GFR at 15-30 ml/min) before cefepime use were significantly (P <0.05) higher risk for developing cefepime-induced neurotoxicity in patient group compared to that in the control group. Age, sex, and other metabolic parameters except GFR before and during, usage of cefepime did not show any statistical difference between the two groups. Conclusion: The present study revealed that cefepime-induced neurotoxicity was prone to develop in patients with impaired renal function before cefepime usage.

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Cefepime: a rare cause of encephalopathy

Cited by 11 publications

References 18 publications

Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

Ceftriaxone-Induced Acute Encephalopathy in a Peritoneal Dialysis Patient

Neurotoxicity by Cefepime: Case-Control Study

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