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Cefepime-Induced Encephalopathy.
Dinesh Keerty1, Naser A Shareef2, Asha Ramsakal3
1Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, USA.
Cureus
|March 17, 2021
Summary
Cefepime antibiotic can cause encephalopathy, a brain dysfunction. Stopping cefepime treatment rapidly resolves these neurological symptoms.
Area of Science:
- Pharmacology
- Neurology
- Infectious Diseases
Background:
- Cefepime is a fourth-generation cephalosporin antibiotic with broad-spectrum activity.
- Cefepime-induced encephalopathy is an underrecognized adverse effect.
- This condition is often associated with renal dysfunction and blood-brain barrier inflammation.
Observation:
- A 74-year-old male with a hepatobiliary abscess due to Pseudomonas infection was treated with intravenous cefepime.
- The patient developed acutely worsening cognitive changes approximately five days after initiating cefepime therapy.
- Elevated cefepime levels (160 µg/mL) were detected.
Findings:
- Cefepime may antagonize gamma-aminobutyric acid A (GABA-A) receptors and inhibit GABA release.
- Clinical manifestations include impaired consciousness, delirium, myoclonus, and seizures.
- Neurotoxicity is linked to elevated cefepime levels, particularly in patients with renal impairment.
Implications:
- Recognizing cefepime as a potential cause of acute encephalopathy is crucial for timely diagnosis.
- Cessation of cefepime therapy is the primary treatment, leading to rapid resolution of neurotoxicity within 48 hours.
- This case highlights the importance of considering drug-induced neurotoxicity in patients presenting with altered mental status.
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