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Journal of Antimicrobial Chemotherapy (2000) 45, 5-7
© 2000 The British Society for Antimicrobial Chemotherapy

Leading articles

Neurotoxicity of carbapenem antibiotics: consequences for their use in bacterial meningitis

S. Ragnar Norrby*

Department of Infectious Diseases and Medical Microbiology, University of Lund, Lund University Hospital, SE 22185 Lund, Sweden

As reviewed by Schliamser et al.,1 ß-lactam antibiotics are potentially neurotoxic and may cause seizures if given in high doses relative to renal function and/or bodyweight. This was especially the case for the carbapenems and penems then studied, i.e. imipenem and FCE 22101 (ritipenem), which in a rabbit model were about 10 times more neurotoxic than benzylpenicillin.2 In patients, imipenem–cilastatin has been documented to cause seizures at a relatively high frequency if overdosed.3 The practical consequences of this are of limited importance if the dosage recommendations of the imipenem–cilastatin manufacturer are followed. However, as demonstrated by Wong et al.,4 the neurotoxic potential of imipenem– cilastatin was prohibitive for its use for the treatment of bacterial meningitis: at a dose of 25 mg/kg qds, seven of 25 children developed seizures and the trial had to be prematurely terminated.

It seems clear that the high degree of neurotoxity of imipenem–cilastatin and . . . [Full Text of this Article]

Pathogenesis of neurotoxicity of carbapenems

Use of meropenem in meningitis

Conclusions

Notes

References


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