Hong Kong Journal of Nephrology

Volume 6 Number 2, 2004

Neurotoxicity Secondary to Intraperitoneally Administered Cefepime: Report of Two Cases

Sze-Kit Yuen

Sai-Ping Yong
Hing-Sum Tsui

Renal Unit, Department of Medicine and Geriatrics, Caritas Medical Centre, Kowloon, Hong Kong SAR, China.

Cefepime is a broad-spectrum antibiotic used successfully as empirical monotherapy in patients with continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Unfortunately, current intraperitoneal dosage recommendations are based on clinical experience rather than solid pharmacokinetic knowledge. We report two cases of cefepime-related confusion in CAPD peritonitis treated with intraperitoneal cefepime at a commonly used dosage. High peritoneal membrane transport characteristics and deteriorating residual renal function may alert clinicians to the risk of cefepime-induced neurotoxicity. Pharmacokinetic data are essential for rational prescription when the drug is to be administered intraperitoneally.

Key words: cefepime, cephalosporins, intraperitoneal, continuous ambulatory peritoneal dialysis, peritonitis

對於因接受連續攜帶式腹膜透析(CAPD)而併發腹膜炎的病人,廣效抗生素 cefepime 的腹膜內施藥的是行之有效的經驗療法之一;然而,在相關的應用上,cefepime 腹膜內劑量的選取主要是基於臨床經驗,缺乏客觀的藥動學數據支持。本文記述了兩宗 CAPD 腹膜炎的案例,在常用劑量 cefepime 腹膜內治療期間發生疑是神經毒性問題(精神紊亂)。在實際的臨床狀況中,腹膜之高運輸表現及殘餘腎功能之衰退,均可能是 cefepime 所致神經毒性的危險因子。因此,理想的 cefepime 腹膜內療法,在實施時必需輔以充足的藥動學數據。

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