![Cefepime Encephalopathy](https://coffeeclinicals.com/wp-content/uploads/2022/11/Cefepime_Sleep.png)
Remember princess Aurora in the classic “Sleeping Beauty” who was cursed by a witch to ‘sleep forever’ if she pricked her finger on a spindle ? Cefepime bestows a similar curse on some patients and you can be the clinician-prince who breaks it!
Cefepime is a commonly used antibiotic in hospitals – often started empirically in severe sepsis or septic shock in ICU given it’s broad anti-bacterial spectrum including Pseudomonas. Lately Cefepime is increasingly recognized as being neurotoxic & can cause encephalopathy with obtundation, hallucinations, myoclonus, seizures. etc.
A common scenario is patients in ICU who do not wake up or remain very drowsy or non-verbal even after critical illness with ABF (Acute Brain Failure) has resolved & are off all sedating meds resulting in expensive & normal brain imaging & EEGs. They start to wake up only after their Cefepime curse – oops i mean course 😉 – is completed ! I thought it was just a coincidence until case reports starting poppping up – like this, this and this . A retrospective case-control study showed Cefepime associated with neurotoxicity was more common when renal failure is present ( likely causes excessive blood levels considering majority of Cefepime is excreted unchanged via urine) Proposed mechanims for this toxicity include GABA receptor antagonism and Carnitine deficiency via inducing renal depletion.
![](https://coffeeclinicals.com/wp-content/uploads/2022/11/cefepime_witch-2.png)
Don’t get me wrong – Cefepime is a good witch to have on your side to kill bad bacteria, but learn to remember that your patient may incur the wrath & curse from the prick of this witch ! Consider stopping or switching Cefepime when you can’t explain your patient’s altered mentation.
💡 Tips reduce the risk of Cefepime neurotoxicity :
– Avoid a blanket use of Cefepime as a empiric antibiotic, reserve it for : previous known pseudomonas infection, febrile neutropenia, severe hospital-acquired or nosocomial pneumonia, etc.
– If you do not grow Pseudomonas in cultures in 2-3 days give switching to other antibiotics like Rocephin / Ceftazidime a thought.
– Be especially picky risk if high for Cefepime-induced Encephalopathy such as Renal dysfunction, Dementia, pre-existing brain injury,etc.
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