Ann Rehabil Med.  2012 Feb;36(1):159-162. 10.5535/arm.2012.36.1.159.

Cefepime Neurotoxicity in Patients with Renal Insufficiency

• Kim SY
• Lee IS
• Park SL
• Lee J

• KMID: 2266796
• DOI: http://doi.org/10.5535/arm.2012.36.1.159

Abstract

Cefepime is a fourth-generation cephalosporin that is active against both gram-positive and gram-negative organisms. It is administered parenterally for the treatment of severe infections. Approximately 85% of the drug is excreted unchanged by the kidneys. Neurotoxicity in patients with renal failure who are treated with cefepime has been reported sporadically. We report on two senile patients with renal impairment who developed neurotoxicity including lethal outcome after treatment with cefepime.

Keyword

Cefepime; Neurotoxicity; Renal failure

MeSH Terms

Cephalosporins
Humans
Kidney
Renal Insufficiency
Cephalosporins

Figure

• 

  Fig. 1 EEG recordings in case 1 (A) and case 2 (B). The EEG recordings revealed diffuse slow-wave activity (delta) and triphasic sharp wave activity, suggesting a metabolic-toxic disturbance.

Reference

1. Rybak M. The pharmacokinetic profile of a new generation of parenteral cephalosporin. Am J Med. 1996; 100:39S–44S. PMID: 8678096.

2. Sonck J, Laureys G, Verbeelen D. The neurotoxicity and safety of treatment with cefepime in patients with renal failure. Nephrol Dial Transplant. 2008; 23:966–970. PMID: 18175786.

3. Lam S, Gomolin IH. Cefepime neurotoxicity: case report, pharmacokinetic considerations, and literature review. Pharmacotherapy. 2006; 26:1169–1174. PMID: 16863493.

4. Fernandez-Torre JL. Cefepime- and cefixime-induced encephalopathy in a patient with normal renal function. Neurology. 2006; 67:367. PMID: 16864850.

5. Chow KM, Hui AC, Szeto CC. Neurotoxicity induced by beta-lactam antibiotics: from bench to bedside. Eur J Clin Microbiol Infect Dis. 2005; 24:649–653. PMID: 16261307.

6. Yahav D, Paul M, Fraser A, Sarid N, Leibovici L. Efficacy and safety of cefepime: a systematic review and meta-analysis. Lancet Infect Dis. 2007; 7:338–348. PMID: 17448937.

7. Neu HC. Safety of cefepime: a new extended-spectrum parenteral cephalosporin. Am J Med. 1996; 100:68S–75S. PMID: 8678100.

8. Chatellier D, Jourdain M, Mangalaboyi J, Ader F, Chopin C, Derambure P, Fourrier F. Cefepime-induced neurotoxicity: an underestimated complication of antibiotherapy in patients with acute renal failure. Intensive Care Med. 2002; 28:214–217. PMID: 11907668.

9. Chow KM, Szeto CC, Hui AC, Wong TY, Li PK. Retrospective review of neurotoxicity induced by cefepime and ceftazidime. Pharmacotherapy. 2003; 23:369–373. PMID: 12627936.

10. Plensa E, Gallardo E, Ribera JM, Batlle M, Oriol A, Costa J. Nonconvulsive status epilepticus associated with cefepime in a patient undergoing autologous stem cell transplantation. Bone Marrow Transplant. 2004; 33:119–120. PMID: 14704665.