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Drug Toxicity: Overview01:00

Drug Toxicity: Overview

Drug toxicity quantifies the harm a compound causes to an organism, varying by dose and potentially impacting whole systems or specific organs like the liver. Toxic reactions may arise from venomous insect or spider bites, with effects ranging from mild symptoms to severe outcomes such as brain damage or death. Common forms of acute poisoning include ethanol intoxication and overdose of pain or fever medications, with substances like GHB and heroin being particularly lethal at doses close to...
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Nerve Excitability Assessment in Chemotherapy-induced Neurotoxicity
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Cefepime-induced neurotoxicity: a systematic review.

Lauren E Payne1, David J Gagnon2, Richard R Riker3

  • 1University of New England College of Pharmacy, 716 Stevens Ave, Portland, ME, 04102, USA. paynele12@gmail.com.

Critical Care (London, England)
|November 16, 2017
PubMed
Summary

Cefepime neurotoxicity, a serious side effect, presents with varied symptoms in ICU patients. Prompt intervention, including drug cessation, typically resolves symptoms and improves outcomes.

Keywords:
Adverse eventsBlood–brain barrierCefepimeCephalosporinComaIntensive care unitsMyoclonusSeizuresStatus epilepticus

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Area of Science:

  • Pharmacology
  • Neuroscience
  • Critical Care Medicine

Background:

  • Cefepime, a broad-spectrum antibiotic, can cause neurotoxicity due to blood-brain barrier penetration and GABA antagonism.
  • Neurotoxic symptoms range from confusion and myoclonus to seizures and coma, affecting up to 15% of ICU patients.
  • Risk factors include renal dysfunction, high dosage, and pre-existing brain injury.

Purpose of the Study:

  • To characterize the clinical presentation of cefepime-induced neurotoxicity.
  • To evaluate the effectiveness of interventions for cefepime neurotoxicity.

Main Methods:

  • A systematic literature review was conducted using CINAHL and MEDLINE databases (1980-2016).
  • Publications describing cefepime-associated neurotoxicity were identified and assessed for eligibility.
  • Data extraction followed PRISMA-P guidelines.

Main Results:

  • 37 articles representing 135 patients were included; median age 69 years, 80% with renal dysfunction, 81% in ICU.
  • Altered mental status was universal, with reduced consciousness (47%), myoclonus (42%), and confusion (42%) most common.
  • Electroencephalography showed abnormalities in 73% of patients; 48% were overdosed, but 26% had neurotoxicity at appropriate doses.
  • Symptom improvement occurred in 89% of patients, with 87% surviving to discharge after interventions like drug discontinuation, antiepileptic drugs, or hemodialysis.

Conclusions:

  • Cefepime neurotoxicity is difficult to diagnose in critically ill patients due to non-specific symptoms.
  • The condition typically resolves with cefepime discontinuation, though additional treatments may be necessary.
  • This adverse effect can occur even with appropriate dosing.