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[Non-convulsive status epilepticus secondary to adjusted cefepime doses in patients with chronic renal failure]
1Servicio de Nefrología, Hospital Clínic i Provincial Universidad de Barcelona, Barcelona.
Abstract:
Fever is one of the most frequent causes of hospital admission in patients with end-stage renal disease. Lack of an identified source of infection and/or lack of clinical response to the first empirical antibiotic treatment favour the use of broader spectrum antibiotics. The availability of fourth-generation cephalosporins (e.g. cefepime) and the increasing incidence of bacterial resistances to classical antibiotics has increased their use in the clinical practice. We present two cases of non-convulsive status epilepticus in patients with advanced chronic renal failure who received cefepime at doses corrected for the degree of renal function according to the manufacturer's instrument as. The clinical symptoms included shouthough, processes, disorientation, loss of attention, and the later appearance of myoclonus. In both cases the electroencephalogram (EEG) was compatible with non-convulsive epileptic status. After cefepime withdrawal there was a clinical remission of symptoms and normalization of the EEG. It is concluded that cefepime treatment can induce a non-convulsive epileptic status in patients with advanced chronic renal failure. Pharmacokinetic studies are urgently needed to clearly define the appropriate dose of cefepime in patients with advanced chronic renal failure.
Insights
In patients with advanced chronic renal failure, cefepime (a fourth-generation cephalosporin) can trigger non-convulsive epileptic status. Dose adjustments are critical to prevent this serious adverse event.
Area of Science:
- Neurology
- Nephrology
- Pharmacology
Background:
- Fever is a common reason for hospitalization in end-stage renal disease (ESRD) patients, often necessitating broad-spectrum antibiotics.
- Increased antibiotic resistance drives the use of advanced antibiotics like fourth-generation cephalosporins, including cefepime.
- Cefepime is frequently prescribed for infections in ESRD patients, with doses typically adjusted for renal function.
Observation:
- Two cases of non-convulsive epileptic status were observed in patients with advanced chronic renal failure receiving cefepime.
- Symptoms included disorientation, attention deficits, and myoclonus, with electroencephalogram (EEG) findings consistent with non-convulsive epileptic status.
- Clinical and EEG improvements occurred after cefepime discontinuation.
Findings:
- Cefepime administration, even at adjusted doses, can precipitate non-convulsive epileptic status in patients with severe renal impairment.
- The study highlights a potential neurotoxic side effect of cefepime in this vulnerable patient population.
- This adverse event underscores the need for careful neurological monitoring during cefepime therapy in ESRD.
Implications:
- Clinicians should consider cefepime-induced neurotoxicity when evaluating altered mental status in ESRD patients.
- Further pharmacokinetic studies are essential to establish optimal and safe cefepime dosing regimens for patients with advanced chronic renal failure.
- Enhanced vigilance and potentially alternative antibiotic choices may be warranted in this patient group to mitigate seizure risk.