Highlights
- •Central nervous system adverse effects provided by cephalosporins are under-suspected and can lead to death.
- •Central nervous system adverse effects can be neurologic and psychiatric.
- •Ceftriaxone is widely represented with several deaths, an awareness should be important for clinicians.
Abstract
Introduction
Among antibiotics, Central Nervous System (CNS) adverse drug reactions (ADRs) are
often under-suspected and overlooked. Cephalosporins are an important cause of drug-induced
CNS ADRs but the characteristics of such ADR have not been fully explored. We aimed
to characterize the profile of cephalosporins serious CNS ADRs.
Method
We performed an analysis of serious reports recorded in the French Pharmacovigilance
database from 1987 to 2017.
Results
A total of 511 serious ADRs reports was analyzed. Patients had a mean age of 67.1 years
and were mainly men (52.5%), with a mean creatinine clearance of 32.9 ml/min. The
most involved molecules were cefepime (33.1%), ceftriaxone (29.7%), ceftazidime (19.6%),
cefotaxime (9%) and cefazoline (2.9%), mostly administered intravenously (87.3%).
A CNS history was observed in 25% of the reports (n = 128). Patients exhibited encephalopathy (30.3%), confusional state (19.4%), convulsion
(15.1%), myoclonia (9.4%), status epilepticus (9.2%), coma (6.3%) and hallucination
(4.3%). The mean time of onset was 7.7 days and the mean duration was 6 days. Cephalosporin
plasma levels were recorded for 153 patients (29.9%) and 107 were above the standards
including 62 (57.9%) related to renal impairment. Electroencephalograms were performed
in 38.2% (n = 195) of the patients and 81% (n = 158) were abnormal.
Conclusion
This study characterizes an off-target CNS ADRs of several cephalosporins. Ceftriaxone
represented a large part of our reports after cefepime and it would be relevant to
warn healthcare professionals. Investigations (EEG, though plasma levels and renal
function) can be precious tools for clinicians to make a prompt diagnosis and improve
patients' outcomes.
Keywords
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Article info
Publication history
Published online: January 16, 2019
Accepted:
January 14,
2019
Received in revised form:
December 19,
2018
Received:
September 28,
2018
Identification
Copyright
© 2019 Published by Elsevier B.V.
