Clinical Pharmacology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Universitat Autònoma de Barcelona, Barcelona, Spain.
Br J Clin Pharmacol. 2021 Apr;87(4):2140-2145. doi: 10.1111/bcp.14582. Epub 2020 Nov 3.
Ten cases of ertapenem neurotoxicity, mainly confusional states, are described, some of them with fatal outcomes. The majority of patients (90%) had a creatinine clearance (CrCl) < 50 mL/min/1.73m at some point during treatment and hypoalbuminaemia was always present when ertapenem treatment was started. The pharmacokinetic and pharmacodynamic properties of this carbapenem could favour a different profile, and approved doses can be excessive in some patients with moderate renal failure (CrCl 31-59 mL/min/1.73 m ). It may be necessary to re-evaluate renal function during treatment and adjust doses or reconsider the adequacy of treatment based on clinical judgement, especially if relevant changes in the CrCl occur (i.e. a reduction to ≤30 mL/min/1.73 m ) or unexplained behavioural disorders are detected. The onset of the symptoms of ertapenem neurotoxicity can be insidious and go unnoticed, and so a knowledge and early suspicion of confusional states are important to improve the patient prognosis.
描述了 10 例厄他培南神经毒性病例，主要表现为意识混乱状态，其中部分病例结局为死亡。大多数患者（90%）在治疗过程中的某个时间点肌酐清除率（CrCl）<50 mL/min/1.73m，并且在开始厄他培南治疗时总是存在低白蛋白血症。这种碳青霉烯类药物的药代动力学和药效学特性可能有利于不同的特征，对于中度肾功能衰竭（CrCl 31-59 mL/min/1.73 m ）的一些患者，批准的剂量可能过高。在治疗过程中可能需要重新评估肾功能，并根据临床判断调整剂量或重新考虑治疗的充分性，特别是如果发生与 CrCl 相关的变化（即减少至≤30 mL/min/1.73 m ）或检测到不明原因的行为障碍时。厄他培南神经毒性的症状可能隐匿且不易察觉，因此了解和早期怀疑意识混乱状态对于改善患者预后非常重要。
