Ceftazidime-Avibactam-Induced Neurotoxicity Manifesting as Seizure in an Older Adult: A Case Report

Abstract: This single-case report describes severe neurotoxicity manifesting as seizure in an older, critically ill patient with acute kidney injury during treatment with ceftazidime-avibactam (CZA-AVI), a combination antibiotic used for multidrug-resistant Gram-negative infections. Although generally safe, neurotoxicity from CZA-AVI, while uncommon, can be severe. The patient, a 78-year-old woman with multiple comorbidities and acute kidney injury, developed impaired consciousness progressing to generalized seizures a few days after initiating CZA-AVI. Electroencephalography confirmed seizure activity. All other potential causes were excluded. Her neurological symptoms resolved completely after discontinuation of CZA-AVI and initiation of antiepileptic therapy. This case highlights that CZA-AVI carries a risk of serious neurotoxicity, particularly in vulnerable populations such as older, critically ill patients with renal impairment. It underscores the imperative for strict adherence to renal dose adjustment guidelines, vigilant neurological monitoring, and immediate consideration of drug-induced encephalopathy in the differential diagnosis of mental status changes in such patients. Awareness of this potential adverse event should be integrated into antimicrobial stewardship programs to optimize patient safety. Keywords: adverse reaction, ceftazidime avibactam sodium, neurotoxicity, risk factors, seizure, therapeutic drug monitoring