Cerebral manifestations of cefepime toxicity in a dialysis patient

Cephalosporins are one of the most widely prescribed groups of antimicrobial agents. In 1999, 2.3 billion dollars were spent on cephalosporins alone. Cefepime is a new fourth-generation cephalosporin with broad-spectrum coverage with twice-daily dosing, an excellent safety profile, and reduced level of resistance compared to other agents. Penicillin and related agents, such as the carbapenems, have long been associated with cerebral side effects and seizures, in particular. We describe a case of CNS-associated cefepime toxicity in a renal failure patient. A 74-year-old woman with a history of dialysis-dependent renal failure, coronary artery disease, peripheral vascular disease, and hypertension developed bacteremia with Pantoea agglomerans sensitive to cefepime. Cefepime 2 grams per day was administered based on recommendations from two medical references.1,2⇓ The patient presented to the emergency department 4 days later with shortness of breath and confusion. Her vital signs were stable. She did not respond to questions but followed simple …