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Cefepime-Induced Neurotoxicity: A Retrospective Cohort Study in a South-Indian Tertiary Health-care Facility
- At: PPR SIG 2021 (2021)
- Type: Digital
- By: M, Sonal Sekhar (Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India, India)
- Co-author(s): Erfan Ali Jani , Sonal Sekhar M, Kavitha Saravu
IntroductionCefepime is a fourth-generation cephalosporin with a broad spectrum of 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.
ObjectivesTo determine the incidence and risk factors for CIN compared to other antibiotics.
MethodsA retrospective cohort study was conducted with 738 patients over eight months in Kasturba Medical College Hospital, Manipal, India. Patients with cefepime were selected as study cohort (SC; n= 496) and other antibiotics were reference cohort (RC; n=242).
ResultsThe results showed 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 (X2 =6.641; p=0.01). SC has 2.29 times increased risk of neurotoxicity compared to RC (OR: 2.29; 95%CI: 1.2-4.38). Risk estimation showed renal failure patients have 5.5 times higher risk for CIN compared to 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.
ConclusionThe study found a higher incidence of CIN than other antibiotics-induced neurotoxicity and a harmful association between cefepime use and the development of CIN. Besides, renal failure is a risk factor for CIN. Therefore, the study warrants the use of cefepime, where no other alternatives are available.
Last update 4 October 2019