Cefepime neurotoxicity: case report, pharmacokinetic considerations, and literature review.
A 67-year-old woman with diabetes mellitus, chronic renal insufficiency, and recurrent urinary tract infections experienced encephalopathy and myoclonus while receiving cefepime. The adverse drug event was accompanied by elevated cefepime levels and abnormal electroencephalograms. This syndrome resolved after discontinuation of cefepime. Neurotoxicity is a known but possibly underreported adverse event associated with cefepime in patients with renal impairment who receive relatively excessive doses. Most cases reverse on drug cessation. In patients with renal disease, the maintenance dosage should be reduced and the patient monitored for neurotoxicity. Cefepime toxicity should be suspected whenever a patient receiving the drug experiences a change in mental status or myoclonus.
Lam
Sum
S
Department of Clinical Pharmacy Practice, College of Pharmacy and Allied Health Professions, St. John's University, Jamaica, New York 11439, USA. lams1@stjohns.edu
Gomolin
Irving H
IH
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics; D000077723:Cefepime; D002511:Cephalosporins / Q000009:adverse effects* / Q000097:blood / Q000493:pharmacokinetics; D004569:Electroencephalography; D005260:Female; D006801:Humans; D009207:Myoclonus / Q000139:chemically induced*; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime