The Trend of Cefepime-Induced Neurotoxicity: A Systematic Review

Abstract

There has been increased use of cefepime due to concerns about the nephrotoxic effects of the combined use of vancomycin and Zosyn. However, cefepime is associated with neurotoxicity. We conducted a systematic review using online data to explore the trend of cefepime-induced neurotoxicity over the last 10 years. Forty-six articles met our inclusion criteria, including 73 cases of cefepime-induced neurotoxicity. We noticed a steady increase in the reports of cefepime-induced neurotoxicity, from one case in 2013 to 11 cases in 2022. Individuals aged 65 and older accounted for most cefepime-induced neurotoxicity cases (52%). The top three indications for cefepime administration included bone and joint infections (25%), urinary tract infections (22.7%), and pneumonia (22.7%). Most patients with renal impairment have never had a renal adjustment of their cefepime dosage (either 2 g 12 hours a day or 2 g eight hours a day). Most cases of cefepime-induced neurotoxicity occurred between days two and five (n=29, 71%), while most resolution occurred between days one and five (n=29, 85%). While cefepime continues to be a popularly used and effective antibiotic against gram-negative bacteria like Pseudomonas aeruginosa, its dosage needs to be adjusted in patients with renal impairment to avoid neurotoxicity.

Keywords: antibiotic; cefepime-induced neurotoxicity; creatinine clearance; encephalopathy; fourth generation cephalosporin; glomerular filtration rate (gfr); nephrotoxic; pseudomonas aeruginosa (p. aeruginosa); renal adjusted dose; renal impairment.

Figure 1. PRISMA flow chart

PRISMA: Preferred Reporting Items for Systemic Reviews and Meta-Analyses; n = number of articles; PubMed = PubMed® database

Figure 2. A chart showing the number of cases in the articles included per year considered (n=73)