The Safety of Treatment with Cefepime in Elderly Patients

Background/Purpose: Cefepime-induced neurotoxicity has been reported worldwide sporadically. Most patients affected are elderly and have renal impairment. Few cases were identified in our institution and prompted this review to formulate measures to prevent its occurrence. Methods: This is a quality improvement study done in the Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. We retrieved case records of patients who received cefepime between March 2014 and September 2015. Demographic data, comorbidities, indication, duration and doses of cefepime were recorded. Case records of patients which developed neurologic symptoms were independently reviewed. Patients were determined to have cefepime-induced neurotoxicity based on set criteria. Results: Total of 279 records were reviewed. Cefepime was administered for a mean duration of 3.2 days. Urinary tract infection was the most common indication for prescribing cefepime. Majority of patients were cognitively impaired (n=174, 62%) and had chronic kidney disease (CKD) (n=157, 56%). Six cases (2.2%) were identified to have cefepime-induced neurotoxicity. The mean daily dose of cefepime administered for this group was lower compared to the rest of the cohort, but the duration of treatment was longer. Mean latency period was 3 days and mean recovery period was 4 days. Predominant symptoms were confusion (n=6) and drowsiness (n=5). Other symptoms were myoclonus (n=2) and agitation (n=2). Eighteen patients received higher dose of cefepime based on creatinine clearance, but none of them developed neurologic symptoms. Conclusion: Since this special group is vulnerable, there should be increased awareness for this condition, diligent adjustment of cefepime dosages according to renal function and timely de-escalation of antibiotics.