Document Detail

The neurotoxicity and safety of treatment with cefepime in patients with renal failure.
MedLine Citation:
PMID:  18175786     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cases of cefepime neurotoxicity have been sporadically reported in patients with renal failure. The neurotoxicity of cefepime might be underestimated and the frequency of its neurotoxic effects may be insufficiently recognized. METHODS: We retrospectively reviewed the files of patients with renal failure who were treated with cefepime and who developed neurological complications. RESULTS: All 8 patients developed decreased conscience, confusion, agitation, global aphasia, myoclonus, chorea-athetosis, convulsions and coma. The latency, the period between the start of treatment and neurological deterioration, was 4,75 +/- 2,55 days (range: 1-10 days). All patients died 17 +/- 14,7 days (range: 1-42 days) after becoming symptomatic. Three of them died shortly after neurological deterioration. Five patients developed a neurological "tableau" with global aphasia. Three patients showed clinical improvement after the discontinuation of cefepime. Electroencephalography revealed diffuse slow-wave activity (delta) and triphasic sharp wave activity. These findings confirm the possible neurotoxicity of treatment with cefepime in patients with renal failure. In none of the deceased patients have we been able to directly demonstrate a causal relationship between neurotoxicity and mortality. However, when a patient treated with cefepime develops neurological deterioration or aphasia, one must be aware of cefepime's potential neurotoxicity and treatment should be stopped. CONCLUSION: We recommend that, in view of the high and unexplained mortality, the use of cefepime in patients with kidney failure should be carefully considered.
J Sonck; G Laureys; D Verbeelen
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Publication Detail:
Type:  Journal Article     Date:  2008-01-05
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  23     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-26     Completed Date:  2008-04-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  966-70     Citation Subset:  IM    
Department of Medicine, Section of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium.
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MeSH Terms
Aged, 80 and over
Anti-Bacterial Agents / adverse effects*,  therapeutic use
Bacterial Infections / drug therapy
Cephalosporins / adverse effects*,  therapeutic use
Dose-Response Relationship, Drug
Glomerular Filtration Rate / drug effects
Kidney Failure / complications*,  physiopathology
Middle Aged
Neurotoxicity Syndromes / etiology*,  physiopathology
Retrospective Studies
Treatment Outcome
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Cephalosporins; 88040-23-7/cefepime

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