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Meropenem at recommended dose is a potential risk for seizure in hemodialysis patient

Abdullah Al-Hwiesh1, Amani Alhwiesh1, Ibrahiem Saeed Abdul-Rahman1

  • 1Department of Internal Medicine, Division of Nephrology, King Fahd Hospital of the University, Alkhobar; Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
|February 10, 2021
PubMed

Insights

Meropenem dosage adjustment is crucial for hemodialysis patients. A case report suggests the standard 500 mg daily dose may cause seizures, especially in patients with lower body mass index.

Area of Science:

  • Pharmacology
  • Nephrology
  • Neurology

Background:

  • Meropenem dosage adjustment is typically recommended for hemodialysis (HD) patients, with approximately 30% cleared during HD sessions.
  • Limited data exists on optimal meropenem dosing to prevent central nervous system (CNS) toxicity in patients undergoing regular HD.

Observation:

  • A 65-year-old Saudi female with end-stage renal disease on regular HD developed tonic-clonic convulsions after the 7th dose of meropenem.
  • Seizures ceased upon discontinuation of meropenem, indicating a potential drug-induced adverse event.

Findings:

  • The standard recommended meropenem dose of 500 mg daily may be excessive for hemodialysis patients.
  • This dosage may increase the risk of CNS toxicity, particularly in Asian patients with lower body mass index.

Implications:

  • Current meropenem dosing guidelines for hemodialysis patients may require revision.
  • Further studies are needed to establish precise meropenem dosing protocols for hemodialysis patients, considering factors like body mass index and ethnicity.
  • This case highlights the importance of vigilant monitoring for adverse neurological effects in patients receiving meropenem during hemodialysis.

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