cefepime and Stroke

Cefepime is a widely used antibiotic which was known to have neurotoxicity resulted from its ability to cross the blood-brain barrier and a wide variety of symptoms had been documented. Here we reported a case of Cefepime induced neurotoxicity with rare presentation. The aim of this study was to improve the knowledge of this condition.. A 89-year-old female with a history of ESRD (end stage renal disease) and superimposed acute cholecystitis was treated with Cefepime. She developed the symptoms of global aphasia, right hemiplegia, leftward eye deviation and abnormal plantar reflex at right foot, which resembled acute ischemic stroke at left MCA (middle cerebral artery), on the fourth day of Cefepime treatment. There was no evidence of acute infarction in MRI (magnetic resonance imaging) of brain and EEG (electroencephalography) revealed NCSE (nonconvulsive status epilepticus). NCSE was suspected to be attributed to Cefepime-induced neurotoxicity. The patient's main risk factors were decreased renal clearance and incorrect dosing. Conslusion: Cefepime-induced neurotoxicity should be suspected in patients who developed neurologic symptoms after the administration of Cefepime. Emergent image study for excluding more commonly seen or critical etiologies and further evaluation with EEG were necessary. For those patients who have risk factors for Cefepime neurotoxicity, such as ESRD, TDM (therapeutic drug monitoring) may be useful in providing close monitoring and preventing adverse effects associated with Cefepime treatment. Keyword: Cefepime, acute ischemic stroke, aphaia, nonconvulsive status epilepticus.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Brain Ischemia; Cefepime; Electroencephalography; Female; Humans; Infarction, Middle Cerebral Artery; Status Epilepticus; Stroke

Topics: Aged, 80 and over; Anti-Bacterial Agents; Brain Ischemia; Cefepime; Cephalosporins; Female; Humans; Myoclonus; Piperacillin, Tazobactam Drug Combination; Stroke

Cefepime (Maxipime) is a fourth-generation cephalosporin commonly used to treat a variety of infections. Its controversial side effect profile is not well appreciated by first-line practitioners. We report a case of urinary tract infection treated with cefepime in a 91-year-old woman. The acute onset of conscuous disturbance was noted on the 9th day of cefepime treatment. Computed tomogram and magnetic resonance image of the brain showed no specific findings. The neurological symptoms and signs such us conscious disturbance, ocular bobbing, asterexis disappeared after discontinuation of cefepime. We suggest that physicians should cefepime as a possible cause of reversible neurological deficits.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefepime; Cephalosporins; Female; Humans; Magnetic Resonance Imaging; Stroke; Urinary Tract Infections