Cefepime Induced Encephalopathy in a Non-dialysis Dependent Chronic Kidney Disease Patient: A Case Report

Giritharan Muniandy, Lydia Kamaruzaman, Tan Hui Jan, Rozita Mohd, Mariamutu Theepa Neesam, Ken Fong Voon, Beng Pau Kiew, Ruslinda Mustafar


Cefepime is a frequently used fourth-generation cephalosporin antibiotic for a wide variety of infections. Toxic levels of this drug can cause neurological complications. The most common neurological adverse event of cefepime is headache and lightheadedness. Here, we presented a case of cefepime induced encephalopathy in a 57-year-old female patient with acute on chronic kidney disease. With an accurate diagnosis that requires a high index of clinical suspicion, prompt management was instituted. She had full resolution of symptoms following discontinuation of the medication and also emergent dialysis.


Cefepime; encephalopathy; chronic kidney disease


Burgess SV, Mabasa VH, Chow I, Ensom MH. Evaluating outcomes of alternative dosing strategies for cefepime: a qualitative systematic review. Ann Pharmacother. 2015;49(3):311-22.

Bazan JA, Martin SI, Kaye KM. Newer beta-lactam antibiotics: doripenem, ceftobiprole, ceftaroline, and cefepime. The Medical Clinics of North America. 2011;95(4):743-60, viii.

Wong KM, Chan WK, Chan YH, Li CS. Cefepime-related neurotoxicity in a haemodialysis patient. Nephrol Dial Transplant. 1999;14(9):2265-6.

Neu HC. Safety of cefepime: a new extended-spectrum parenteral cephalosporin. Am J Med. 1996;100(6A):68S-75S.

Durand-Maugard C, Lemaire-Hurtel AS, Gras-Champel V, et al. Blood and CSF monitoring of cefepime-induced neurotoxicity: nine case reports. J Antimicrobial Chemother. 2012;67(5):1297-9.

FDA Drug Safety Communication: Cefepime and risk of seizure in patients not receiving dosage adjustments for kidney impairment. 2012.

Eggers V, Fugener K, Hein OV, et al. Antibiotic- mediated release of tumour necrosis factor alpha and norharman in patients with hospital-acquired pneumonia and septic encephalopathy. Intensive Care Medicine. 2004;30(8):1544-51.

Desarro A, Ammendola D, Zappala M, Grasso S, Desarro GB. Relationship between structure and convulsant properties of some beta-lactam antibiotics following intracerebroventricular microinjection in rats. Antimicrob Agents Ch. 1995;39(1):232-7.

Jallon P, Fankhauser L, Du Pasquier R, et al. Severe but reversible encephalopathy associated with cefepime. Neurophysiologie clinique - Clinical neurophysiology. 2000;30(6):383-6.

Martinez-Rodriguez JE, Barriga FJ, Santamaria J, et al. Nonconvulsive status epilepticus associated with cephalosporins in patients with renal failure. Am J Med. 2001;111(2):115-9.

Grill MF, Maganti R. Cephalosporin-induced neurotoxicity: clinical manifestations, potential pathogenic mechanisms, and the role of electroencephalographic monitoring. Ann Pharmacother. 2008;42(12):1843-50.

Fugate JE, Kalimullah EA, Hocker SE, Clark SL, Wijdicks EF, Rabinstein AA. Cefepime neurotoxicity in the intensive care unit: a cause of severe, underappreciated encephalopathy. Crit Care. 2013;17(6):R264.

Paul M, Yahav D, Fraser A, Leibovici L. Empirical antibiotic monotherapy for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrobial Chemother. 2006;57(2):176-89.

Song JC. Cefepime: FDA drug safety communication on non-convulsive status epilepticus risk. Infectious Disease (alert). 2012.

Lamoth F, Buclin T, Pascual A, et al. High cefepime plasma concentrations and neurological toxicity in febrile neutropenic patients with mild impairment of renal function. Antimicrob Agents Chemother. 2010;54(10):4360-7.

Huwyler T, Lenggenhager L, Abbas M, et al. Cefepime plasma concentrations and clinical toxicity: a retrospective cohort study. Clinical Microbiology Infection. 2017;23(7):454-9.

Sonck J, Laureys G, Verbeelen D. The neurotoxicity and safety of treatment with cefepime in patients with renal failure. Nephrol Dial Transplant. 2008;23(3):966-70.

Chatellier D, Jourdain M, Mangalaboyi J, et al. Cefepime- induced neurotoxicity: an underestimated complication of antibiotherapy in patients with acute renal failure. Intensive Care Medicine. 2002;28(2):214-7.

Payne LE, Gagnon DJ, Riker RR, et al. Cefepime-induced neurotoxicity: a systematic review. Crit Care. 2017;21(1):276.

Gangireddy VG, Mitchell LC, Coleman T. Cefepime neurotoxicity despite renal adjusted dosing. Scandinavian J Infect Dis. 2011;43(10):827-9.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.