Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan,
Int J Clin Pharm. 2013 Oct;35(5):683-7. doi: 10.1007/s11096-013-9799-3. Epub 2013 Jun 4.
The US Food and Drug Administration reported seizures associated with the use of cefepime (primarily in patients with renal impairment who did not receive appropriate dose adjustments of cefepime).
The maximum dose of cefepime in the USA (6 g per day) is higher than that in Japan (4 g per day). We investigated the prevalence of convulsions associated with the use of cefepime by comparing it with that of meropenem.
A retrospective study was undertaken in 183 patients treated with cefepime and 745 patients treated with meropenem over 2 years at Ehime University Hospital. Cefepime or meropenem-associated convulsions were defined according to the following criteria: (1) administration or dose escalation of diazepam, phenytoin, phenobarbital and thiamylal given via the intravenous route (2) convulsions recorded in medical records during administration of cefepime or meropenem.
The prevalence of convulsions was significantly greater in the cefepime treated group than in the meropenem-treated group. Among the patients who had cefepime-associated convulsions, none had renal failure. Cefepime-associated convulsions occurred only in patients with brain disorders.
Cefepime-associated convulsions should be recognized as potential complications even in patients with normal renal function. Brain disorders may increase the risk of cefepime-associated convulsions.
美国食品和药物管理局报告了与头孢吡肟（主要是在未接受头孢吡肟适当剂量调整的肾功能损害患者中）使用相关的癫痫发作。
美国头孢吡肟的最大剂量（每天 6 克）高于日本（每天 4 克）。我们通过与美罗培南比较，调查与头孢吡肟使用相关的癫痫发作的患病率。
在爱媛大学医院进行了一项回顾性研究，纳入了 183 例使用头孢吡肟和 745 例使用美罗培南治疗的患者，时间为 2 年。根据以下标准定义头孢吡肟或美罗培南相关癫痫发作：（1）通过静脉途径给予地西泮、苯妥英钠、苯巴比妥和硫喷妥钠的给药或剂量升级；（2）在使用头孢吡肟或美罗培南期间记录在病历中的癫痫发作。
头孢吡肟治疗组癫痫发作的患病率明显高于美罗培南治疗组。在发生头孢吡肟相关癫痫发作的患者中，均无肾衰竭。头孢吡肟相关癫痫发作仅发生在有脑部疾病的患者中。
即使在肾功能正常的患者中，也应认识到头孢吡肟相关癫痫发作是潜在的并发症。脑部疾病可能会增加头孢吡肟相关癫痫发作的风险。
