Continuous kidney replacement therapy in neurotoxicity by cefepime: Case report
PDF (Español)


Renal Replacement Therapy

How to Cite

Santiago Ausecha DR, García Velásquez CM, Ballesteros Castro DA, Mantilla Villareal AC. Continuous kidney replacement therapy in neurotoxicity by cefepime: Case report. Rev. Colomb. Nefrol. [Internet]. 2024 Mar. 8 [cited 2024 Jul. 25];11(1). Available from:


Background: Cefepime is an anti-pseudomonal cephalosporin, also classified as a fourth generation agent. Cefepime neurotoxicity is a rare adverse effect, usually occurring in patients with chronic renal disease, even with dose adjustment according to the glomerular filtration rate, although it can also occur when renal function is normal. The most frequent manifestations of cefepime encephalopathy are: Decreased level of consciousness, myoclonus and non-convulsive status epilepticus. Treatment includes cefepime discontinuation, dose reduction, benzodiazepines or renal replacement therapies. We present a patient with chronic kidney disease on peritoneal dialysis who presented with cefepime neurotoxicity and hemodynamic instability, who was treated with continuous renal replacement therapy.

Purpose: To describe the case of neurotoxicity due to cefepime in a patient with chronic kidney disease.

Case presentation: 63-year-old male patient with chronic kidney disease on peritoneal dialysis hospitalized for soft tissue infection under management with cefepime who presented a generalized tonic-clonic seizure episode followed by cardiorespiratory arrest witnessed with successful resuscitation, for which he was initiated with venovenous hemodiafiltration He continued for 72h and later hemodialysis due to volume overload, with which his neurological status improved, later the patient died of sepsis.

Discussion and conclusion: neurotoxicity due to cefepime is a rare event, however, it is necessary to become aware of the manifestations of the disease to carry out an early detection. Continuous renal replacement therapies can be used in some patients, thereby accelerating the elimination of cefepime.
PDF (Español)


Brunton LL, Hilal-Dandan RK, Knollmann BC. Goodman and Gilman the pharmacological basis of therapeutics. Estados Unidos: McGraw-Hill Education; 2018.

Appa AA, Jain R, Rakita RM, Hakimian S, Pottinger PS. Characterizing Cefepime Neurotoxicity: A Systematic Review. Open Forum Infect Dis. 2017;4(4):1-5.

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

Johnson E, Hannawi Y, Martinez NC, Ritzl EK. Cefepime-Associated SIRPIDs in a patient with normal renal function. Neurohospitalist. 2016;6(5):167-9.

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

Garin A, Bavozet F. Myoclonic status epilepticus induced by cefepime overdose requiring haemodialysis. BMJ Case Rep. 2019;12(6):2018-20.

FDA. Maxipime (cefepime hydrochloride) Injection, Powder, For Solution. FDA.

Avedissian SN, Pais G, Joshi MD, Rhodes NJ, Scheetz MH. A Translational Pharmacokinetic Rat Model of Cerebral Spinal Fluid and Plasma Concentrations of Cefepime. mSphere. 2019;4(1):1-11.

WHO [Internet]. Ginebra, Suiza: Holloway K. et al; 2003 [updated 2004; cited 2024].

Sugimoto M, Uchida I, Mashimo T, Yamazaki S, Hatano K, Ikeda F, et al. Evidence for the involvement of GABAA receptor blockade in convulsions induced by cephalosporins. Neuropharmacology. 2003;45(3):304-14.

Fernández-Fernández FJ, Ameneiros-Lago E. Cefepime-Induced Encephalopathy: Could Carnitine Deficiency Contribute to Neurotoxicity? Neurohospitalist. 2020;10(2):81.

Schlidt K, Kadlec A, Bhandari S, Jha P. Cefepime-induced Neurotoxicity: Five Cases Reported in a Single Institution. Cureus. 2018;10(11):1-7.

Boschung-Pasquier L, Atkinson A, Kastner LK, Banholzer S, Haschke M, Buetti N, et al. Cefepime neurotoxicity: thresholds and risk factors. A retrospective cohort study. Clin Microbiol Infect. 2020;26(3):333-9.

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

Barbhaiya RH, Knupp CA, Forgue T, Matzke GR, Guay DR, Pittman KA, et al. Pharmacokinetics of cefepime in subjects with renal insufficiency. Clin Pharmacol Ther. 1990;48(3):268-76.

Schmaldienst S, Traunmüller F, Burgmann H, Rosenkranz AR, Thalhammer-Scherrer R, Hörl WH, et al. Multiple-dose pharmacokinetics of cefepime in long-term hemodialysis with high-flux membranes. Eur J Clin Pharmacol. 2000;56(1):61-4.

Barbhaiya RH, Knupp CA, Pfeffer M, Zaccardelli D, Dukes GM, Mattern W, et al. Pharmacokinetics of cefepime in patients undergoing continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother. 1992;36(7):1387-91.

Malone RS, Fish DN, Abraham E, Teitelbaum I. Pharmacokinetics of Cefepime during Continuous Renal Replacement Therapy in Critically Ill Patients. Antimicrob Agents Chemother. 2001;45(1):3148-55.

Isla A, Rodríguez Gascón A, Maynar J, Arzuaga A, Toral D, Pedraz JL. Cefepime and continuous renal replacement therapy (CRRT): in vitro permeability of two CRRT membranes and pharmacokinetics in four critically ill patients. Clin Ther. 2005;27(5):599-608.

Allaouchiche B, Breilh D, Jaumain H, Gaillard B, Renard S, Saux MC. Pharmacokinetics of cefepime during continuous venovenous hemodiafiltration. Antimicrob Agents Chemother. 1997;41(11):2424-7.

Bresson J, Paugam-Burtz C, Josserand J, Bardin C, Mantz J, Pease S. Cefepime overdosage with neurotoxicity recovered by high-volume haemofiltration. J Antimicrob Chemother. 2008;62(4):849-50.

Wilson FP, Bachhuber MA, Caroff D, Adler R, Fish D, Berns J. Low cefepime concentrations during high blood and dialysate flow continuous venovenous hemodialysis. Antimicrob Agents Chemother. 2012;56(4):2178-80.

Sharma S, Puri Vi, Bloom E, Raja R. Cefepime Induced Neurotoxicity: Impact of Early Nephrologic Intervention. Am J Kidney Dis. 2016;67(5):A1-118.

Creative Commons License

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




Download data is not yet available.