Central nervous system damage induced by cefepime:literature analysis of 65 cases

WEI Feng; HU Xi; CHEN Jian-bo

doi:10.3969/j.issn.1672-8157.2013.03.008

Abstract：Objective:To investigate the clinical characteristics and occurrence reasons of cefepime-inducing central nervous system damage, and provide reference for rational use of drugs in clinic. Methods:With the key words of cefepime, nerve, encephalopathy, mind, dystaxia and epilepsy, we searched Chinese Journal Full-text Database (CNKI database) and Chinese Science and Technology Periodical Database (VIP information). And the case reports of cefepime-inducing central nervous system adverse reaction published in domestic literatures from 2008 to 2012 were collected and analyzed in respect of the basic characteristics of the patients, the usage of drugs, clinical manifestations of central neurotoxicity, the relationship between the abnormal renal function and neurotoxicity, the relevance evaluation of drug use, treatment and prognosis. Results: There were 65 patients (29 men and 36 women) with central nervous system damage induced by cefepime. The central neurotoxicity mostly occurred in patients with the age of 71–80 years. The longest incubation period of neurotoxicity was 6 days, and mostly in the range of 1–5 days. The main clinical manifestations were disorder of consciousness (such as confusion, coma, lags in response, expression of indifference, etc) and neuronal excitability (irritability, paraphasia, convulsion, epilepsy, etc). Of the 65 patients, 4 were cured, 59 improved and 2 died after the treatment. Conclusion:Cefepime-inducing central nervous system damage may be relevant to the change of blood-brain barrier permeability, ages and renal functions. Therefore, the dosage of cefepime should be adjusted based on creatinine clearance rate of the patient, and cefepime should be discontinued immediately when unexplained central nervous system damage appears.