Cefepime-Induced Neurotoxicity: When Should Alternative Agents Be Considered?

Cefepime is a broad-spectrum cephalosporin used in various clinical settings (such as febrile neutropenia associated with hematologic malignancy) — nevertheless, cefepime-induced neurotoxicity (CIN) can cause altered mental status and seizures. French researchers prospectively evaluated CIN in hospitalized patients with febrile neutropenia who were receiving continuously infused cefepime along with therapeutic drug monitoring (TDM). Plasma cefepime concentrations were measured in patients who did or did not experience CIN during the first 10 days of cefepime therapy.

Overall, CIN occurred in 10% of cefepime courses a median 5 days into therapy, with a neurotoxicity threshold of 37 mg/L. Patients with CIN were older (64 vs. 55 years), had a l…