title: Comparison of the prevalence of convulsions associated with the use of cefepime and meropenem.
abstract: BACKGROUND
  The US Food and Drug Administration reported seizures associated with the use of cefepime (primarily in patients with renal impairment who did not receive appropriate dose adjustments of cefepime).
  
  
  OBJECTIVE
  The maximum dose of cefepime in the USA (6 g per day) is higher than that in Japan (4 g per day). We investigated the prevalence of convulsions associated with the use of cefepime by comparing it with that of meropenem.
  
  
  METHODS
  A retrospective study was undertaken in 183 patients treated with cefepime and 745 patients treated with meropenem over 2 years at Ehime University Hospital. Cefepime or meropenem-associated convulsions were defined according to the following criteria: (1) administration or dose escalation of diazepam, phenytoin, phenobarbital and thiamylal given via the intravenous route (2) convulsions recorded in medical records during administration of cefepime or meropenem.
  
  
  RESULTS
  The prevalence of convulsions was significantly greater in the cefepime treated group than in the meropenem-treated group. Among the patients who had cefepime-associated convulsions, none had renal failure. Cefepime-associated convulsions occurred only in patients with brain disorders.
  
  
  CONCLUSIONS
  Cefepime-associated convulsions should be recognized as potential complications even in patients with normal renal function. Brain disorders may increase the risk of cefepime-associated convulsions.
authors.affiliation: Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan, akiki@m.ehime-u.ac.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tanaka
authors.forename: Kenshi
authors.initials: K
authors.lastname: Takechi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Watanabe
authors.forename: Mamoru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Katsuya
authors.initials: K
authors.lastname: Suemaru
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Araki
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001927:Brain Diseases / Q000150:complications; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D007564:Japan / Q000453:epidemiology; D008297:Male; D000077731:Meropenem; D020258:Neurotoxicity Syndromes / Q000453:epidemiology*; D015995:Prevalence; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D012306:Risk; D012640:Seizures / Q000139:chemically induced* / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013845:Thienamycins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D013845:Thienamycins; D000077723:Cefepime; D000077731:Meropenem