Cefepime is renally cleared and crosses into the central nervous system more than many beta-lactams. When doses are not reduced for impaired kidney function, levels rise and patients can develop confusion, reduced consciousness, myoclonus, or non-convulsive status epilepticus.
It is easily attributed to sepsis or uraemia. Recalculate the dose for current renal function, consider an EEG when consciousness is impaired, and switch or reduce the drug. Symptoms usually resolve once exposure falls, and dialysis removes cefepime.
- Adjust cefepime dose for current, not admission, renal function.
- Suspect neurotoxicity with new confusion, myoclonus or reduced consciousness.
- Consider an EEG to look for non-convulsive seizures.
- Reduce the dose or switch agent; dialysis removes cefepime.
- Older patients and those with kidney disease are at highest risk.
Why it matters
Cefepime neurotoxicity is reversible but often missed because sepsis offers a ready explanation.
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