Association of antibiotics with status epilepticus
Neurological Sciences,  Clinical Article

Misra 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.

Methods
  • 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  • The offending antibiotics were withdrawn and the patients were treated with phenytoin, lorazepam, sodium valproate or midazolam.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.

Results
  • 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.
  • 10% SE patients may be related to antibiotics.

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