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Cephalosporin-induced Neurological Toxicity in Elderly Patients with Preserved Renal Function

Gideon Charach, Ori Argov, Hilla Nochomovich, Karyn Geiger, Lior Charach, Ronen Steinvil, Ori Rogowski,  Itamar Grosskopf

Cephalosporins are widely used in patients for the treatment of serious gram positive and gram-negative infections. Cephalosporins can induce some serious side effects, including neurotoxicity, mood disorder, hallucinations; however, non-convulsive status epilepticus has rarely been reported. We report three cases of acute reversible neurotoxicity associated with cephalosporins. Three patients without chronic kidney disease developed altered consciousness, hallucinations during ceftriaxone treatment for urinary tract infection and pneumonia and non-convulsive status epilepticus (NCSE) during cefazoline treatment for cellulitis-three days after initiation of the treatment. The electroencephalogram demonstrated continuous bursts of generalized, high-voltage, 1 Hz to 2 Hz sharp wave activity. Neurologic symptoms disappeared two days following withdrawal of ceftriaxone or cefazolin. The possibility of cephalosporin-induced neurotoxicity should be considered in patients developing neurological signs especially cognitive and seizures appearance during cephalosporin use and the discontinuation of the drug could lead to rapid complete neurological improvement.