Association of antibiotics with status epilepticus
Neurological Sciences, 03/30/2012Misra UK et al.
The findings suggest that the antibiotic should be carefully chosen in patients with hepatic and renal failure, and the dose should be modified.
In a retrospective review, 12 out of 117 (10%) patients with SE had temporal association with antibiotic administration.
Their medical history, clinical findings, and duration and type of SE were recorded.
Serum chemistry, blood counts, cranial MRI, EEG and CSF examination were carried out.
The offending antibiotics were withdrawn and the patients were treated with phenytoin, lorazepam, sodium valproate or midazolam.
The response to treatment was recorded and death during hospital stay noted.
The median age of the patients was 36 (18 and 74) years and 5 were females.
Eight patients had convulsive and four nonconvulsive SE.
The median duration of status was 12 h.
The antibiotics related to SE included intravenous cephalosporin (ceftazidime 5, amoxyclavulenic acid 2, piperacillin 2, cefepime and quinolones (levofloxacin 3, ofloxacin 1, ciprofloxacin in isolation or in combinations.
Five patients had hepatic (41.7%) and 6 (50%) renal failure; the later received higher than the recommended dose of antibiotics.
Cranial MRI was abnormal in 7 out of 9 (77.8%) patients that include cortical lesion in one, corticosubcortical in three and subcortical in three.
SE responded to first antiepileptic drug in four and to second in five patients.
Three patients (25%) had refractory SE.
Eight (66.7%) patients died and death was related to SE in 2 patients.
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