Seizure history does not elevate risk of cefepime-induced neurotoxicity

Patients with a history of seizures do not appear to be at an increased risk of cefepime-induced neurotoxicity (CIN), according to a study.

However, age >65 years, acute kidney injury (AKI) during treatment with cefepime, and admission to the intensive care unit (ICU) are all associated with a higher likelihood of CIN.

This retrospective matched cohort study compared the rates of CIN in individuals with and without seizure history and identified the risk factors associated with CIN. 

Patients admitted to a university hospital from January 2019 to December 2022 who initiated treatment with cefepime with and without a baseline history of seizure were included. The authors then matched eligible participants in a 1:1 ratio by age, sex, and month of admission.

In total, 150 patients met the inclusion criteria, with 75 in each group. No statistically significant difference was noted in CIN between those with and without a history of seizure (9 vs 7; p=0.7923).

The following factors were significantly associated with CIN: age >65 years (odds ratio [OR], 5.8, 95 percent confidence interval [CI], 1.194–27.996), AKI during cefepime administration (OR, 13.8, 95 percent CI, 2.528–75.206), and an ICU admission (OR, 8.6, 95 percent CI, 1.735–42.624).

“These results suggest that it may be safe to administer cefepime to patients with a history of seizure in the appropriate clinical setting,” the authors said. 

Cefepime is used to treat nosocomial infections and works as a carbapenem-sparing agent for the management of AmpC inducible bacteria.