Tie Teck Kim
Changi General Hospital, Singapore
Title: Consider Ertapenem as culprit for central nervous system related adverse effects
Biography
Biography: Tie Teck Kim
Abstract
Statement of the Problem: Ertapenem use has been associated with central nervous system (CNS) related adverse effects (AEs) which include delirium, hallucinations, altered mental status (AMS), stroke like symptoms and seizures. We describe baseline characteristics and clinical features in four patients who developed CNS related AEs while receiving ertapenem during a period of six consecutive months in 2016.
Methodology & Theoretical Orientation: We retrospectively reviewed patients on ertapenem and identified the ones who developed CNS related AEs attributed to ertapenem use from April till October 2016.
Findings: Patient one (no renal impairment) was prescribed ertapenem for complicated intra- abdominal infection. He was noted to be drowsy on day 12 of ertapenem. Over the next 1-2 days, he developed auditory hallucinations, jerky limb movements and fluctuating level of consciousness. He was switched to aztreonam. Patient two (no renal impairment) developed confusion and hallucinations (visual, auditory and tactile) on day 25 of ertapenem which was being administered for tubo-ovarian abscess. Ertapenem was substituted to meropenem. Patient three (known end stage renal failure) developed seizure while on day 28 of ertapenem which was prescribed for bilateral renal abscess. No further episode of seizure was observed after ertapenem was switched to piperacillin/tazobactam. Patient four (known chronic kidney disease) was receiving ertapenem for complicated urinary tract infection. He was noted to be delirious on day nine of ertapenem. Patient was switched to meropenem. In these patients, average age was 65 years. Male to female ratio was 1:1. None of the patients had previous history of seizure or CNS disorders. Two patients had normal renal functions. Toxic & metabolic causes were excluded. Computed tomography (CT) of brain was normal in all cases. Dose was renally adjusted in two patients. Ertapenem therapeutic drug monitoring (TDM) was not locally available. Symptom improvement was noted 3-4 days after ertapenem discontinuation in all patients.
Conclusion & Significance: Patients who develop these AEs can deteriorate rather unexpectedly which leads to extensive investigations and increase in health care cost. The cost can be minimized if physicians are acquainted to consider ertapenem as an offender agent. However appropriate workup to eliminate alternate etiology also needs to be considered at the same time as dictated by the clinical scenario. Ertapenem TDM might give information on CNS AEs in future studies.