Cefepime-induced neurotoxicity in a patient with renal dysfunction: a case report





Cefepime is an antimicrobial widely used in the hospital environment. During the development phases, the drug proved to be safe and, therefore, was approved and marketed. After the commercialization of cefepime, case reports involving a serious adverse reaction were emerging. Cefepime-Induced Neurotoxicity (CIN) is a reaction that occurs most often in patients with renal dysfunction, damage to the blood-brain barrier or advanced age. Dose adjustment should be made according to creatinine clearance in order to prevent adverse reaction. Among the symptoms are drowsiness, tremors, myoclonus, agitation, lowered level of consciousness, convulsions and coma. The electroencephalogram can be used to aid in the diagnosis, but it is not specific for this condition. In this article, we present a case report of a 52-year-old woman with acute renal failure who presented CIN after using cefepime, despite dose adjustments according to renal function. The patient presented the symptoms even after discontinuing the medication and hemodialysis did not reverse the condition. The patient’s physiological characteristics may have contributed to the outcome of the case. The description of CIN cases in the literature is important for a better understanding of the pathophysiology that involves the adverse reaction and prevention of new cases.


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Maan G, Keitoku K, Kimura N, et al. Cefepime-induced neurotoxicity: systematic review. J Antimicrob Chemother. 2022 Oct 28;77(11):2908-2921. doi: 10.1093/jac/dkac271.

Martin SI, Kaye KM. Beta-lactam antibiotics: newer formulations and newer agents. Infect Dis Clin North Am. 2004 Sep;18(3):603-19, ix. doi: 10.1016/j.idc.2004.04.006.

Payne LE, Gagnon DJ, Riker RR, et al. Cefepime-induced neurotoxicity: a systematic review. Crit Care. 2017 Nov 14;21(1):276. doi: 10.1186/s13054-017-1856-1.

Triplett JD, Lawn ND, Chan J, et al. Cephalosporin-related neurotoxicity: Metabolic encephalopathy or non-convulsive status epilepticus? J Clin Neurosci. 2019 Sep;67:163-166. doi: 10.1016/j.jocn.2019.05.035.

Kalil AC. Is cefepime safe for clinical use? A Bayesian viewpoint. J Antimicrob Chemother. 2011 Jun;66(6):1207-9. doi: 10.1093/jac/dkr138.

INSUFICIÊNCIA RENAL AGUDA [Internet]. Sociedade Brasileira de Nefrologia, 2007. Disponível em: https://www.sbn.org.br/profissional/utilidades/diretrizes-de-nefrologia/. Acesso em: 20/03/23.

Pettit NN, Han Z, Nguyen CT, Pisano J. Cefepime-Induced Encephalopathy, Single-Center Incidence, Complexities in Diagnosis. Open Forum Infect Dis. 2017 Dec 8;4(4):ofx265. doi: 10.1093/ofid/ofx265.

Wong KM, Chan WK, Chan YH, et al. Cefepime-related neurotoxicity in a haemodialysis patient. Nephrol Dial Transplant. 1999 Sep;14(9):2265-6. doi: 10.1093/ndt/14.9.2265.

Appa AA, Jain R, Rakita RM, Hakimian S, Pottinger PS. Characterizing Cefepime Neurotoxicity: A Systematic Review. Open Forum Infect Dis. 2017 Oct 10;4(4):ofx170. doi: 10.1093/ofid/ofx170.

Benarroch E. What is the role of GABA Transporters in seizures? Neurology Sep 2021, 97(12)580-584; DOI: 10.1212/WNL.0000000000012574.

Schachter, SC. Antiseizure medications: Mechanism of action, pharmacology, and adverse effects. UpToDate; 2022. Disponível em: https://www.uptodate.com/contents/antiseizure-medications-mechanism-of-action-pharmacology-an- d-adverse-effects?search=Antiseizure%20medications:%20Mechanism%20of%20action,%20pharmacology,%20and%20adverse%20effects&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Acesso em: 11/01/2023.

Lamoth F, Buclin T, Pascual A, et al. High cefepime plasma concentrations and neurological toxicity in febrile neutropenic patients with mild impairment of renal function. Antimicrob Agents Chemother. 2010 Oct;54(10):4360-7. doi: 10.1128/AAC.01595-08.

Cefepime: Drug information. Uptodate; 2022. Disponível em: https://www.uptodate.com/contents/cefepime-drug-information?search=CEFEPIME&source=panel_search_result&selectedTitle=1~107&usage_type=panel&kp_tab=drug_general&display_rank=1 . Acesso em: 11/01/2023.

Cloridrato de cefepima: pó para solução injetável. Responsável técnico Sidnei Bianchini Junior. Cosmópolis - SP: Antibióticos do Brasil Ltda, 2017. Bula de remédio. Disponível em: https://www.ablbrasil.com.br/wp-content/uploads/2018/05/Cefepima-Profissional.pdf.

Silva D. Encefalopatia induzida por cefepima: incidência e fatores de risco [dissertação de mestrado]. Universidade Federal do Rio Grande do Sul, Porto Alegre, 2010.

Lee SJ. Cefepime-induced neurotoxicity. J Neurocrit Care. 2019;12(2):74–84. doi: https://doi.org/10.18700/jnc.190109.

Ruiz de Villa A, Charles K, Bassi R, Spencer S, Bazikian Y. Approach to Cefepime-Induced Neurotoxicity in the Setting of Chronic Kidney Disease: A Case Report and Review of Literature. Cureus. 2022 Jun 16;14(6):e26005. doi: 10.7759/cureus.26005.

Hughes S, Heard KL, Mughal N, Moore LSP. Optimization of antimicrobial dosing in patients with acute kidney injury: a single-centre observational study. JAC Antimicrob Resist. 2022 Jul 25;4(4):dlac080. doi: 10.1093/jacamr/dlac080.



How to Cite

SILVA DV, VERONEZE C, GUIMARÃES PL. Cefepime-induced neurotoxicity in a patient with renal dysfunction: a case report. Rev Bras Farm Hosp Serv Saude [Internet]. 2023Mar.30 [cited 2024May18];14(1):917. Available from: https://rbfhss.org.br/sbrafh/article/view/917