title: Probable Nonconvulsive Status Epilepticus With the Use of High-Dose Continuous Infusion Ceftazidime.
abstract: Multidrug resistant (MDR) bacterial infections are a major concern of health care providers due to their increasing incidence and associated mortality. In some cases, few or no antibiotics have preserved activity. Beta-lactam administration via continuous infusion can optimize time over minimum inhibitory concentration (MIC). In some cases, use of high-dose continuous infusion (HDCI) may be necessary to achieve serum levels in excess of nonsusceptible MIC values. The use of HDCI beta-lactams is not without risk, specifically neurotoxic adverse effects, which appear dose related. We describe a 64-year-old male who experienced myoclonus and nonconvulsive status epilepticus while receiving HDCI ceftazidime for treatment of multidrug resistant Pseudomonas aeruginosa bacteremia. This report serves as a cautionary example of the potential toxicities associated with HDCI beta-lactams and supports the importance of risk-benefit analysis prior to and during treatment. Additionally, the use of serum drug level monitoring may be necessary to better prevent or predict toxicity.
authors.affiliation: Department of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX, USA RDCollins@mdanderson.org.
authors.forename: Reagan D
authors.initials: RD
authors.lastname: Collins
authors.affiliation: Department of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Tverdek
authors.affiliation: Department of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Bruno
authors.affiliation: University of Houston College of Pharmacy, Houston, TX, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Coyle
mesh_terms: D016470:Bacteremia / Q000188:drug therapy; D002442:Ceftazidime / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D018432:Drug Resistance, Multiple; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009207:Myoclonus / Q000139:chemically induced; D013226:Status Epilepticus / Q000139:chemically induced*
chemical_list: D002442:Ceftazidime
keywords: adverse drug reactions; bacterial infections; cephalosporins; drug administration; seizures