Cefepime-Associated Neurotoxicity – Who’s at Risk?

April 7, 2020

Written by Clay Smith

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Patients with severe renal dysfunction receiving high-dose cefepime may have higher risk of cefepime-associated neurotoxicity (CAN).

Why does this matter?
I was not aware of this potential adverse effect. “Cefepime is a widely used antibiotic with neurotoxicity attributed to its ability to cross the blood–brain barrier and exhibit concentration-dependent ϒ-aminobutyric acid (GABA) antagonism. Neurotoxic symptoms include depressed consciousness, encephalopathy, aphasia, myoclonus, seizures, and coma.” From Critical Care. Who is at risk for this?

Kick the CAN
This was a retrospective review of 200 critically ill patients with impaired renal function who received cefepime. The overall incidence of CAN was 6.5%. There was numerical but not statistical difference in high-dose vs low-dose: 10% vs. 4%, OR 2.82 (0.84-9.48). There were just 5 patients in the high-dose group who also had severe renal dysfunction. There were more cases of CAN in this group with severe renal dysfunction, but this was not statistically significant: 0% low-dose vs. 16% high-dose, p=0.064. This study can only suggest that higher dose and poorer renal function are risk factors. I included it because I was unaware of this side effect of cefepime and wanted to learn more. I hope this will add to your differential diagnosis.

Source
Effect of Cefepime on Neurotoxicity Development in Critically Ill Adults with Renal Dysfunction. Chest. 2020 Mar 5. pii: S0012-3692(20)30429-3. doi: 10.1016/j.chest.2020.01.051. [Epub ahead of print]

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