Myoclonic jerks secondary to piperacillin and nafcillin

Area of Science:

• Neuropharmacology
• Infectious Diseases

Background:

• Beta-lactam antibiotics, including piperacillin and nafcillin, are commonly used for bacterial infections.
• Penicillin, a related antibiotic, is known to cause neurological adverse effects such as seizures and myoclonus.

Observation:

• A 66-year-old male patient developed intermittent myoclonic jerks and encephalopathy while on intravenous piperacillin and nafcillin.
• Symptoms resolved upon discontinuation of these antibiotics.
• Head CT scan was negative, and the patient had no prior history of seizures or myoclonus.

Findings:

• Piperacillin and nafcillin share structural similarities with penicillin.
• These antibiotics may induce myoclonus and seizures by interfering with gamma-aminobutyric acid (GABA) mediated inhibitory neurotransmission.
• The mechanism involves blocking chloride channels in GABA type A receptors.

Implications:

• Clinicians should be aware of the potential epileptogenic and encephalopathic effects of piperacillin, nafcillin, and related beta-lactam antibiotics.
• Monitoring for neurological adverse events is crucial in patients receiving these medications.
• This case underscores the importance of considering antibiotic-induced neurotoxicity in patients presenting with unexplained neurological symptoms.