title: Retrospective review of neurotoxicity induced by cefepime and ceftazidime.
abstract: We reviewed 42 cases of cefepime-induced neurotoxicity and 12 cases of ceftazidime-induced neurotoxicity from the literature and our institution. Clinical characteristics and timing of diagnosis were examined. Common findings were confusion with temporospatial disorientation (96% of patients), myoclonus (33%), and seizures (13%). These neurologic disorders frequently are encountered in uremic and elderly patients, who often are in a confused state when they visit their physician. The risk of delayed diagnosis was greater with cefepime than ceftazidime neurotoxicity. The median interval between symptom onset and diagnosis of cefepime versus ceftazidime neurotoxicity was 5 and 3 days, respectively (p=0.005). Delayed diagnosis of cefepime neurotoxicity may be due to lack of awareness of the adverse effect. Data gathered since these two broad-spectrum antibiotics were first marketed underscore the potential for neurologic adverse events secondary to their administration. Thus, clinicians' awareness must be increased so that the time between symptom onset and diagnosis can be reduced.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Kai Ming
authors.initials: KM
authors.lastname: Chow
authors.forename: Cheuk Chun
authors.initials: CC
authors.lastname: Szeto
authors.forename: Andrew Che-Fai
authors.initials: AC
authors.lastname: Hui
authors.forename: Teresa Yuk-Hwa
authors.initials: TY
authors.lastname: Wong
authors.forename: Philip Kam-Tao
authors.initials: PK
authors.lastname: Li
mesh_terms: D000368:Aged; D000077723:Cefepime; D002442:Ceftazidime / Q000009:adverse effects*; D002511:Cephalosporins / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000175:diagnosis / Q000209:etiology*; D010531:Peritoneal Dialysis, Continuous Ambulatory
chemical_list: D002511:Cephalosporins; D000077723:Cefepime; D002442:Ceftazidime