Association of antibiotics with status epilepticus
Neurological Sciences, 03/30/2012  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.

• 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• The offending antibiotics were withdrawn and the patients were treated with phenytoin, lorazepam, sodium valproate or midazolam.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.
• 10% SE patients may be related to antibiotics.