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NDT Advance Access originally published online on January 5, 2008
Nephrology Dialysis Transplantation 2008 23(3):966-970; doi:10.1093/ndt/gfm713
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The neurotoxicity and safety of treatment with cefepime in patients with renal failure

J. Sonck, G. Laureys and D. Verbeelen

Department of Medicine, Sections of Nephrology and Neurology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium

D. Verbeelen, Section of Nephrology, UZ Brussel, Laarbeeklaan 101, B-1090 Brussel, Belgium. E-mail: dierik.verbeelen{at}uzbrussel.be



  Abstract

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 neurologicaldeterioration, 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.

Keywords: cefepime; neurotoxicity; renal failure; kidney disease

Received for publication: 11. 9.07
Accepted in revised form: 12. 9.07


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