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Cefuroxime-induced encephalopathy
Y O Herishanu1, M Zlotnik, M Mostoslavsky
1Department of Neurology, Soroka Medical Center and Goldman Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Abstract:
We describe four patients who developed an encephalopathic syndrome characterized by obtundation or stupor, myoclonic jerks, and asterixis in association with cefuroxime therapy. Three patients had renal failure. These cases suggest that cefuroxime in overdose or in conventional doses in patients with renal failure can cause a reversible encephalopathy. This syndrome may have been unrecognized because it usually occurs in severely ill patients with additional causes for encephalopathy.
Insights
Cefuroxime, an antibiotic, can cause reversible encephalopathy in patients with kidney failure. This neurological syndrome, marked by confusion and tremors, may be overlooked in critically ill patients.
Area of Science:
- Neurology
- Pharmacology
- Nephrology
Background:
- Cefuroxime is a widely used cephalosporin antibiotic.
- Encephalopathy is a general term for brain dysfunction.
- Renal failure can impair drug clearance and increase toxicity risk.
Observation:
- Four patients developed encephalopathy during cefuroxime therapy.
- Symptoms included obtundation, stupor, myoclonic jerks, and asterixis.
- Three of the affected patients had pre-existing renal failure.
Findings:
- Cefuroxime therapy, particularly in overdose or in patients with renal impairment, can lead to a reversible encephalopathic syndrome.
- The neurological symptoms observed are characteristic of toxic encephalopathy.
- The syndrome may be underrecognized due to confounding factors in critically ill patients.
Implications:
- Clinicians should consider cefuroxime as a potential cause of encephalopathy in patients with renal failure.
- Early recognition and discontinuation of cefuroxime may lead to complete neurological recovery.
- This highlights the importance of dose adjustment and monitoring in patients with impaired renal function.