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Reversible coma secondary to cefepime neurotoxicity.
Sergio Abanades1, Juan Nolla, Ana Rodríguez-Campello
1Pharmacology Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain. sabanades@imim.es
The Annals of Pharmacotherapy
|February 26, 2004
Summary
Cefepime (a powerful antibiotic) can cause neurotoxicity, leading to nonconvulsive status epilepticus, especially in patients with acute renal failure. Early detection and cefepime withdrawal are crucial for recovery.
Area of Science:
- Pharmacology
- Neurology
- Nephrology
Background:
- Cefepime is a broad-spectrum cephalosporin antibiotic used for severe infections.
- Acute renal failure can impair drug clearance, increasing the risk of toxicity.
- Nonconvulsive status epilepticus is a form of epilepsy that may present as altered consciousness.
Observation:
- A patient with acute myeloid leukemia developed acute renal failure during cefepime treatment.
- Altered consciousness and nonconvulsive status epilepticus were observed in the patient.
- Cefepime was discontinued, leading to the resolution of epileptiform activity and improved consciousness.
Findings:
- The study suggests a probable causal link between cefepime use and neurotoxicity manifesting as nonconvulsive status epilepticus.
- High cefepime serum concentrations due to impaired renal clearance are implicated in its neurotoxic effects.
- Uremia may contribute to blood-brain barrier dysfunction, exacerbating cefepime neurotoxicity.
Implications:
- Clinicians should consider cefepime neurotoxicity in patients with renal impairment presenting with altered consciousness.
- Nonconvulsive status epilepticus can be a subtle complication in critically ill patients and should be suspected.
- Prompt recognition and management, including cefepime withdrawal, can lead to full recovery.