Ertapenem neurotoxicity in liver transplantation

Area of Science:

• Pharmacology
• Neuroscience
• Infectious Diseases

Background:

• Carbapenems are broad-spectrum beta-lactam antibiotics crucial for treating severe bacterial infections.
• While generally well-tolerated, carbapenems can penetrate the central nervous system (CNS), posing a risk for neurotoxicity.
• Neurotoxicity is a known, albeit rare, adverse effect, with imipenem historically linked to higher incidences than ertapenem.

Discussion:

• A recent large study (n=544) challenges the notion of ertapenem's low neurotoxicity risk, reporting an incidence of 4.6%.
• This finding highlights the potential for ertapenem-induced neurotoxicity, manifesting as seizures, encephalopathy, or hallucinations.
• Associated risk factors identified include advanced age and renal dysfunction, correlating with ertapenem's significant renal metabolism (80%).

Key Insights:

• Ertapenem, a commonly used carbapenem, is associated with a notable incidence of neurotoxicity (4.6%) in a recent study.
• The study underscores the importance of considering neurotoxicity as a potential adverse effect of ertapenem, not just imipenem.
• Patient factors like advanced age and impaired renal function are critical in predicting ertapenem-related neurotoxicity.

Outlook:

• Further research is warranted to elucidate the precise mechanisms of ertapenem neurotoxicity.
• Clinical vigilance for neurotoxic symptoms is recommended in patients receiving ertapenem, especially those with identified risk factors.
• This study may inform revised prescribing guidelines and patient monitoring protocols for carbapenem antibiotics.