Piperacillin/Tazobactam-Induced Seizure Rapidly Reversed by High Flux Hemodialysis in a Patient on Peritoneal Dialysis

Lin, Chin‐Sheng; Cheng, Changming; Lin, Shih‐Hua; Chou, Chung-Hsing

doi:10.1097/maj.0b013e31803195e7

Cited by 28 publications

(20 citation statements)

References 13 publications

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“…Given the underlying pathophysiology of interaction of penicillin with the gamma-aminobutyric acid type A (GABA-A) receptor chloride channel, it is likely that these two antibiotics may interact in a similar way, and possibly reduce inward inhibitory chloride fluxes into both spinal and supra-spinal neurons. Piperacillin has been noted to not only induce an encephalopathy, 1 but can also produce seizures as shown by Lin et al, 2 who rapidly reversed this by high-flux hemodialysis in a 57 year old end stage renal disease patient who developed 2 generalized tonic-clonic seizures after five 250 mg doses of piperacillin/tazobactam…”

Section: Discussionmentioning

confidence: 94%

Myoclonic jerks secondary to piperacillin and nafcillin

Meyer

2014

Neurol Int

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A 66-year-old male receiving intravenous piperacillin and nafcillin for a post-surgical wound infection developed intermittent myoclonic jerks of all four extremities that disappeared after discontinuation of these two medications. In addition there was a mild yet definite intermittent encephalopathic effect; head computed tomography examination as negative and there was no prior history for seizure or myoclonus. These two beta lactam ring antibiotics are structurally similar to penicillin, which is well known to induce not only myoclonus but also seizure activity by reducing the gamma-aminobutyric acid (GABA) induced inhibitory currents by inducing an open chloride channel block of the GABA type A receptors within the brain. Clinicians need to be fully aware of the potential epileptogenic effects of piperacillin, nafcillin, and related antibiotics.

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Section: Discussionmentioning

confidence: 94%

Myoclonic jerks secondary to piperacillin and nafcillin

Meyer

2014

Neurol Int

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“…In addition, C.S. Lin et al [3] and W. Arkaravichien et al [4] reported on the occurrence of a seizure by piperacillin-tazobactam and cefazolin, respectively, which were intravenously injected into patients with weakened renal function. Yoshima et al [5] reported on the occurrence of a seizure after an intravenous injection of cefotaxime to a 45-year-old male who was hospitalized with acute cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

‘Tonic clonic seizure’ secondary to lumbar spine surgery: a case report

Cho

Park

Choi

et al. 2010

Eur Orthop Traumatol

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As the average life expectancy is prolonged and the quality of life improves, interest in lumbar spinal stenosis is increasing. Surgical therapy is conducted if there is no symptomatic improvement after an appropriate conservative treatment. However, even after a surgical treatment of lumbar spinal stenosis, various complications, such as infections and dysfunctions in the cardiovascular or nervous system, can occur. Among the various complications, a postoperative seizure is not very common. Although they can be caused by drugs if the patient has an internal disease, particularly a hypofunction in the renal system or an immunologic anomaly, it occurs rarely without a history or an internal problem. The authors experienced a case of tonic clonic seizure secondary to lumbar spine surgery, and report it in this paper with a review of literature.

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“…Penicillin G has been used as a representative β-lactam antibiotic, and induced seizures in experimental animals (Stankiewicz et al, 1995;Bağirici and Bostanci, 2006) and humans (Chow et al, 2005;Lin et al, 2007). However, the incidence of seizures in clinical treatment is low and this is associated with the high dose administered to patients (Zaccara et al, 1990;Barrons et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

Establishment of a novel experimental protocol for drug-induced seizure liability screening based on a locomotor activity assay in zebrafish

et al. 2014

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-As drug-induced seizures have severe impact on drug development, evaluating seizure induction potential of candidate drugs at the early stages of drug discovery is important. A novel assay system using zebrafish has attracted interest as a high throughput toxicological in vivo assay system, and we tried to establish an experimental method for drug-induced seizure liability on the basis of locomotor activity in zebrafish. We monitored locomotor activity at high-speed movement (> 20 mm/sec) for 60 min immediately after exposure, and assessed seizure liability potential in some drugs using locomotor activity. However this experimental procedure was not sufficient for predicting seizures because the potential of several drugs with demonstrated seizure potential in mammals was not detected. We, therefore, added other parameters for locomotor activity such as extending exposure time or conducting flashlight stimulation (10 Hz) which is a known seizure induction stimulus, and these additional parameters improved seizure potential detection in some drugs. The validation study using the improved methodology was used to assess 52 commercially available drugs, and the prediction rate was approximately 70%. The experimental protocol established in this present study is considered useful for seizure potential screening during early stages of drug discovery.Key words: Zebrafish, Locomotor activity, Seizure, Extending exposure time, Flashlight stimulation Correspondence: Naoteru Koseki (E-mail: naoteru-koseki@ds-pharma.co.jp) Original ArticleThe Journal of Toxicological Sciences (J. Toxicol. Sci.) Vol.39, No.4, 579-600, 2014 Vol. 39 No. 4 579 through the blood-brain barrier (BBB). Since such assays are conducted with a focus on specific neural networks or cells associated with seizures, performing an evaluation using above alternative methods is direct and limited. On the basis of the aforementioned findings, a test system that can take pharmacokinetic effects into account and can be used to perform an evaluation under conditions closer to whole body is considered desirable. As such, an in vivo evaluation system using Caenorhabditis elegans (C. elegans), which is one of the nematodes with gamma-aminobutyratergic (GABAergic) neurons related to seizures, has been reported (Locke et al., 2006;Pandey et al., 2010), and an evaluation using behavioral assessment of such organism is expected. However, nematodes are very different from mammals in terms of the anatomical structure of central nervous system (CNS) or pharmacokinetics. Therefore, performing an assessment which approximates the evaluation of a conventional study using rodents is considered to be difficult.Zebrafish is a vertebrate and its genomic homology to humans is approximately 70% (Howe et al., 2013). In addition, zebrafish can be utilized in early stage drug screening in recent decades. For these reasons, an evaluation using zebrafish has recently been given attention as a novel in vivo evaluation system for safety assessment. Since zebrafish have tele...

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Piperacillin/Tazobactam-Induced Seizure Rapidly Reversed by High Flux Hemodialysis in a Patient on Peritoneal Dialysis

Cited by 28 publications

References 13 publications

Myoclonic jerks secondary to piperacillin and nafcillin

Myoclonic jerks secondary to piperacillin and nafcillin

‘Tonic clonic seizure’ secondary to lumbar spine surgery: a case report

Establishment of a novel experimental protocol for drug-induced seizure liability screening based on a locomotor activity assay in zebrafish

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