title: Ertapenem-induced acute reversible peripheral neuropathy in chronic kidney disease: 3 case reports.
abstract: BACKGROUND
  Ertapenem is a broad-spectrum and long-acting carbapenem which is predominantly eliminated by the kidneys, and it requires dose adjustment in renal failure. Although it is known that excessive doses of ertapenem can cause neurotoxicity, there are very few case reports of ertapenem-induced reversible peripheral neuropathy in the literature when used with renal adjusted doses.
  
  
  METHODS
  We report 3 patients with a history of stage 4 or 5 chronic kidney disease (CKD) who developed acute reversible peripheral neuropathy proven with electroencephalography (EEG) and electromyography (EMG). All patients received renal adjusted doses of ertapenem for complicated urinary tract infection (UTI). We also discuss the incidence of carbapenem-related neurotoxicity, mechanisms, and risk factors with a review of the literature.
  
  
  RESULTS
  All patients developed acute peripheral, and additionally one acute central nervous system, neuropathy within 1 week of treatment with ertapenem, which was confirmed by EMG. Complete clinical recovery was obtained in all patients within 2 weeks of cessation of ertapenem treatment, and electromyography was confirmatory in all patients.
  
  
  CONCLUSIONS
  Ertapenem is potentially neurotoxic in patients with CKD even when it is given with renal adjusted doses according to recommendations. Although carbapenem-related neurotoxicity most commonly manifests as seizures, our series indicates that acute and reversible peripheral neuropathy can also develop. Clinicians administering ertapenem for patients with a GFR of < 30 mL/min/1.73 m2 should be cautious.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Department of Internal Medicine, School of Medicine, Recep Tayyip Erdogan University, Rize, Department of Nephrology, Sisli Etfal Educational and Research Hospital, Istanbul, and Department of Neurology, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey.
authors.forename: Ekrem
authors.initials: E
authors.lastname: Kara
authors.forename: Osman Zikrullah
authors.initials: OZ
authors.lastname: Sahin
authors.forename: Teslime
authors.initials: T
authors.lastname: Ayaz
authors.forename: Safak
authors.initials: S
authors.lastname: Yildirim
authors.forename: Tuncay
authors.initials: T
authors.lastname: Sahutoglu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Tufekci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004569:Electroencephalography / Q000187:drug effects; D004576:Electromyography / Q000187:drug effects; D013293:Enterococcus faecalis / Q000302:isolation & purification; D000077727:Ertapenem; D004927:Escherichia coli Infections / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy*; D047090:beta-Lactams / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000077727:Ertapenem