Severe but reversible encephalopathy associated with cefepime.

Area of Science:

• Pharmacology
• Nephrology
• Neurology

Background:

• Cefepime is a broad-spectrum parenteral cephalosporin antibiotic.
• Renal impairment can affect drug clearance and increase the risk of adverse events.
• Encephalopathy is a serious neurological complication that can occur in various clinical settings.

Purpose of the Study:

• To report and analyze cases of severe encephalopathy associated with cefepime use in patients with renal impairment.
• To investigate the relationship between cefepime administration and the development of encephalopathy.
• To provide recommendations for cefepime dosage adjustments in renally impaired individuals.

Main Methods:

• Retrospective analysis of 19 patients with renal impairment who developed severe encephalopathy.
• Patients received cefepime for various infections over a three-year period.
• Clinical presentation, electroencephalogram (EEG) findings, and response to cefepime discontinuation were documented.

Main Results:

• All 19 patients (aged 57-91 years) exhibited a prolonged confusional state.
• EEG revealed diffuse rhythmic non-reactive triphasic sharp waves.
• Electroclinical symptoms resolved within 24-48 hours after discontinuing cefepime, establishing a clear drug-related link.

Conclusions:

• Cefepime administration can precipitate severe encephalopathy in patients with compromised renal function.
• The observed encephalopathy is directly related to cefepime intake and is reversible upon drug withdrawal.
• It is crucial to reduce cefepime dosage in patients with renal impairment to mitigate the risk of neurological toxicity.