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How epileptogenic are the recent antibiotics?
P Hantson1, F Léonard, J M Maloteaux
1Department of Intensive Care, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium. hantson@rean.ucl.ac.be
Objective:
To review the clinical and experimental data concerning the serious neurologic adverse events, and more particularly seizures, which could be related to the administration of recent antibiotics, with special reference to cephalosporins, monobactams, carbapenems, and fluoroquinolones.
Data Sources:
We have searched in the MEDLINE database over the years 1966-1998 the pertinent publications dealing with antibiotics related neurotoxicity. We used the thesaurus function and the following key words: antibiotics, neurotoxicity, seizures. Additional references were found in the articles sorted by the MEDLINE search.
Data Synthesis:
Neurotoxic manifestations following antibiotics administration are infrequently encountered under usual conditions. Experimental studies are helpful to demonstrate that these compounds might interact with a major component of the neurotransmission, the gamma aminobutyric acid (GABA) receptor complex. Structure-toxicity relationships can be described. For the clinician, the recognition of some predisposing factors related either to the patient (age, previous central nervous system disorder ...) or to the drug metabolism (reduced renal clearance, drug interactions ...) may help to minimise the risk of adverse neurologic manifestations. Several factors have to be taken into account before assessing causality: delay from administration, evolution, origin of the adverse event (risk factors, other drugs, non pharmacological origin), possibility of rechallenge, confirmation by biological testing or in vitro experiments....
Insights
Recent antibiotics, particularly cephalosporins and fluoroquinolones, can cause serious neurologic adverse events like seizures by affecting the GABA receptor. Clinicians should consider patient factors and drug metabolism to minimize risks.
Area of Science:
- Pharmacology
- Neuroscience
- Clinical Medicine
Background:
- Antibiotics, including cephalosporins, monobactams, carbapenems, and fluoroquinolones, are essential for treating infections.
- Serious neurologic adverse events, particularly seizures, have been anecdotally linked to antibiotic use.
Purpose of the Study:
- To review clinical and experimental data on antibiotic-associated serious neurologic adverse events, focusing on seizures.
- To examine the relationship between recent antibiotic classes and neurotoxicity.
Main Methods:
- Searched MEDLINE database (1966-1998) for publications on antibiotic neurotoxicity.
- Utilized keywords such as 'antibiotics,' 'neurotoxicity,' and 'seizures.'
- Included additional references from sorted articles.
Main Results:
- Antibiotic-induced neurotoxicity is infrequent but can occur.
- Experimental data suggest interaction with the gamma-aminobutyric acid (GABA) receptor complex.
- Structure-toxicity relationships are identifiable.
- Predisposing patient factors (e.g., age, CNS disorders) and drug metabolism (e.g., renal clearance, interactions) influence risk.
- Assessing causality requires considering administration delay, event evolution, risk factors, and potential rechallenge.
Conclusions:
- Antibiotics can cause neurotoxicity, potentially through GABA receptor interaction.
- Understanding predisposing factors and drug metabolism is crucial for risk mitigation.
- Careful evaluation is necessary to establish a causal link between antibiotics and neurologic events.