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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
  • Abstract:

    Introduction

    Cefepime 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.

    Objectives

    To determine the incidence and risk factors for CIN compared to other antibiotics.

    Methods

    A 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).

    Results

    The 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.

    Conclusion

    The 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

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