Carbapenem associated seizure in a severe melioidosis patient: A case report

Yıl 2013, Cilt: 18 Sayı: 2, 92 - 96, 03.07.2013

Josephine Henry Basil Chee Ping Chong

Öz

Abstract. The use of carbapenems has beenassociated with increased risk of seizure with imipenem having a higherpropensity to induce seizure as compared to meropenem. As there is limited report onthe cross-reactivity between these two agents, clinicians may choose to switchthe antibiotic regimen to meropenem whenever an imipenem associated seizure issuspected. We described a 67-year-old woman who was admittedto the intensive care unit due to severe melioidosis. She experienced anepisode of myoclonus jerks following two doses of imipenem 500 mg givenintravenously at 12 hour interval. Two hours after her first seizure, thepatient experienced two more myoclonus jerks which were two hours apart of eachother. Imipenemwas then discontinued and meropenem 1 g stat and followed by 500 mg every 12 hourly was givenintravenously. However, patient continued to experience myoclonus jerks withthe first episode occurring four hours after the initiation of meropenem.Phenytoin 100 mg every 8 hourly was given intravenously for the management ofseizure. However, the frequency of myoclonus jerks increased to a total of 14episodes on the next day.  The phenytointherapy was subsequently substituted with intravenous sodium valproate 750 mgstat followed by 400 mg every 12 hourly. With this change in treatment,patient’s seizure was resolved. The present case showed thepossibility of cross-reactivity in neurotoxicity which occurred across the useof imipenem and meropenem. Key words: Carbapenem, imipenem,meropenem, seizure, melioidosis

Anahtar Kelimeler

Carbapenem, imipenem, meropenem, seizure, melioidosis

Kaynakça

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