Imipenem-induced seizure: a case of inappropriate, excessive, and prolonged surgical prophylaxis

Area of Science:

• Pharmacology
• Clinical Neurology
• Infectious Diseases

Background:

• Imipenem-cilastatin is a critical broad-spectrum antibiotic for resistant infections.
• Central nervous system (CNS) toxicity, including seizures, is a known adverse drug reaction (ADR) associated with imipenem, occurring in 1.5-10% of patients.
• Appropriate utilization is key to managing severe infections and preventing complications.

Observation:

• A case study details a patient with no prior seizure history who experienced a generalized tonic-clonic seizure.
• The seizure was induced by imipenem-cilastatin administered inappropriately for surgical prophylaxis at excessive doses (1g every 6 hours) for a prolonged duration (24 days).
• This adverse drug event highlights the potential neurotoxicity of imipenem when dosing guidelines are not followed.

Findings:

• Improper dosing and prolonged administration of imipenem-cilastatin can precipitate seizures.
• The risk of drug-induced seizures is elevated when therapeutic drug levels are exceeded, particularly in critically ill patients.
• This case underscores the importance of adhering to recommended dosing protocols for potent antibiotics.

Implications:

• Identification of this ADR prompted significant clinical and administrative changes within the institution.
• Pharmacists play a vital role in preventing adverse drug reactions through therapeutic drug monitoring and pharmaceutical care.
• Individualizing drug regimens based on patient-specific factors is essential for optimizing outcomes and ensuring patient safety.