Related Experiment Video
Updated: Aug 29, 2025
Acute Kidney Injury Model Induced by Cisplatin in Adult Zebrafish
Published on: May 15, 2021
Cefepime-Associated Neurotoxicity in a Pediatric Patient With Stage V Chronic Kidney Disease
Horace Rhodes Hambrick1, Kathryn Pavia2, Sonya Tang Girdwood3,4,5
1Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Cefepime can cause neurotoxicity in children, especially those with kidney problems. Monitoring cefepime levels in at-risk pediatric patients may prevent adverse neurological effects.
Area of Science:
- Pediatric Nephrology
- Neuropharmacology
- Infectious Diseases
Background:
- Cefepime, a broad-spectrum antibiotic, is associated with neurotoxicity in adults, particularly with high concentrations.
- Adults with renal impairment or CNS anomalies face increased risk of cefepime-induced neurotoxicity.
- Limited pediatric data exists on cefepime's neurotoxic effects.
Observation:
- A 2-year-old child with chronic kidney disease developed agitation, tremor, and inconsolability.
- The patient was receiving cefepime for Serratia marcescens bacteremia.
- Symptoms resolved upon cefepime discontinuation, coinciding with an elevated cefepime trough level.
Findings:
- Pediatric patients with kidney disease are susceptible to cefepime-related neurological changes.
- Elevated cefepime trough levels correlated with observed neurotoxicity in this case.
- Cefepime discontinuation led to the resolution of neurological symptoms.
Implications:
- Highlights the risk of cefepime neurotoxicity in pediatric patients with renal dysfunction.
- Suggests therapeutic drug monitoring for cefepime in at-risk children.
- Informs appropriate antimicrobial dosing strategies to avoid cefepime toxicity in vulnerable pediatric populations.
Abstract:
Background: Studies in adult patients suggest cefepime can cause neurotoxicity, including disorientation, seizures, and coma, particularly when present at high concentrations. Patients with underlying kidney dysfunction or central nervous system anomalies are at particularly high risk. There is a relative paucity of pediatric literature on the neurotoxic effects of cefepime. Case Report: Herein is reported the case of a 2-year-old patient with chronic kidney disease receiving cefepime for Serratia marcescens bacteremia who experienced agitation, tremor, and inconsolability in the setting of an elevated cefepime trough that improved with cefepime discontinuation alone. Conclusions: Pediatric patients with acute and chronic kidney disease are at risk of cefepime-related neurologic changes. Therapeutic drug monitoring for cefepime in patients with kidney dysfunction or baseline neurologic abnormalities may help inform appropriate antimicrobial dosing and avoidance of toxicity.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:18Chronic Kidney Disease IV: Nursing Management
01:20Acute Kidney Injury V: Interprofessional Care
01:29Acute Kidney Injury III: Clinical Manifestations
01:24Chronic Kidney Disease II: Clinical Manifestations