Cefepime-Induced Neurotoxicity: A Review of the Evidence

Purpose Cefepime-induced neurotoxicity is a relatively underappreciated and unrecognized adverse event in current clinical practice. Because cefepime is widely used in many hospitals, it is vital that clinicians be aware of this adverse event. Methods A systematic review of the literature was conducted to highlight the current evidence linking cefepime and neurotoxicity. Results More than 40 case reports were identified and analyzed for evidence of cefepime-induced neurotoxicity. Confusion, encephalopathy, coma, myoclonus, nonconvulsive status epilepticus, and frank seizures have been described. Most cases occurred in patients with impaired renal function. Onset of neurotoxicity ranged from 1 to 16 days. On discontinuation of cefepime, neurologic function returned to baseline. Conclusions Cefepime-induced neurotoxicity occurs primarily in patients with impaired renal function; however, several cases have occurred in patients with normal renal function. Most cases of neurotoxicity have arisen in patients who did not receive appropriate dose adjustment for renal impairment. The range of toxicity and latency are broad, thus clinicians must be aware of this adverse event and take all of the necessary steps to prevent the occurrence of neurotoxicity.