Cefepime-induced Neurotoxicity: A Retrospective Cohort Study in a South-Indian Tertiary Healthcare Facility

• Published in: Current drug safety Vol. 18; no. 1; p. 69
• Main Authors: Alijani, Erfan, Miraj, Sonal Sekhar, Kurian, Shilia Jacob, Rao, Mahadev, Saravu, Kavitha
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 01-01-2023
• Subjects: Anti-Bacterial Agents - adverse effects; Cefepime - adverse effects; Cephalosporins - adverse effects; Humans; Neurotoxicity Syndromes - diagnosis; Neurotoxicity Syndromes - epidemiology; Neurotoxicity Syndromes - etiology; Renal Insufficiency - drug therapy; Retrospective Studies; Tertiary Healthcare; cefepime; neurotoxicity; Adverse effects; antibiotics; neurotoxic effects; drug safety
• ISSN: 2212-3911
• DOI: 10.2174/1574886317666220309090408

Cefepime is a fourth-generation cephalosporin with a broad spectrum coverage and anti-pseudomonal activity. The safety profile of cefepime was relatively favourable until neurotoxicity was first reported in 1999. Despite cefepime-induced neurotoxicity (CIN), it continues to be a principal part of parenteral treatment for various infections.
The study aimed to determine the incidence and risk factors for CIN compared to other antibiotics.
A retrospective cohort study was conducted involving 738 patients over eight months in Kasturba Medical College and Hospital, Manipal, India. Patients with cefepime were selected as study cohort (SC; n= 496), and other antibiotics were included in the reference cohort (RC; n=242).
The results showed that 53 (10.7%) patients developed neurotoxicity in the SC, whereas 12 (5%) patients in the RC. A significant association was found between neurotoxicity and cefepime use (X
=6.641; p=0.01). SC has a 2.29 times increased risk of neurotoxicity than RC (OR: 2.29; 95% CI: 1.2-4.38). Risk estimation showed that renal failure patients had a 5.5 times higher risk for CIN than non-renal failure patients (OR: 5.5; 95% CI: 2.98 - 10.17). CIN symptoms were disorientation (38.5%), loss of consciousness (23.1%), drowsiness (18.5%), etc. The calculated number needed to harm (NNH) for cefepime was 17.2.
The study found a higher incidence of CIN compared to other antibiotics-induced neurotoxicity and a harmful association between cefepime use and CIN development. Besides, renal failure is a risk factor for CIN. Therefore, the study warrants the use of cefepime, where no other alternatives are available.