Neurotoxicity Induced by Ertapenem in Patients of a General Hospital
DOI:
https://doi.org/10.20453/rmh.v37i1.6748Keywords:
ertapenem, neurotoxicity syndromes, drug-related side effects and adverse reactions, hypoalbuminemia, chronic renal insufficiencyAbstract
Objective: To describe the clinical characteristics and risk factors related to ertapenem-induced neurotoxicity in patients at a Peruvian hospital. Methods: A retrospective case series study was conducted, including seven cases recorded between 2023 and 2024. Neurotoxicity was defined as the presence of confusion, hallucinations, delirium, or other neurological symptoms that were resolved after discontinuing or substituting the antibiotic. Medical history, renal function, serum albumin, and hemoglobin levels were analyzed, and the Naranjo Scale was applied to assess the probability of causality. Results: Patients were over 60 years old with comorbidities such as hypertension (85.7%), chronic kidney disease (71.4%), and diabetes mellitus (57.14%). Neurological symptoms appeared on average 5.7 days after starting treatment, with confusion and psychomotor agitation being the most frequent. The average duration of ertapenem use was 7 days, and symptoms took 4.1 days to resolve after drug discontinuation. All cases were classified as "probable" according to the Naranjo Scale. Conclusion: Ertapenem-induced neurotoxicity was related to factors such as renal disease, hypoalbuminemia, and advanced age. Dose adjustment and monitoring of risk factors are recommended to minimize complications and optimize its use in clinical practice.
Downloads
References
Congeni BL. Ertapenem. Expert Opin Pharmacother. 2010;11(4):669-72. doi: 10.1517/14656561003631397
El Nekidy WS, Elrefaei H, St John TJL, Attallah NM, Kablaoui F, Nusair A, et al. Ertapenem neurotoxicity in hemodialysis patients-safe and effective dosing is still needed: a retrospective study and literature review. Ann Pharmacother. 2021;55(1):52–58. doi:10.1177/1060028020938059
Mitaka H, Hasegawa S, Lan KF, Jain R, Rakita RM, Pottinger PS. Characterizing ertapenem neurotoxicity: a systematic review and experience at a tertiary medical center. Open Forum Infect Dis. 2024;11(5):ofae214. doi:10.1093/ofid/ofae214
Hsaiky LM, Salinitri FD, Wong J, Jennings SLT, Desai NH, Lobkovich AM, et al. Pharmacokinetics and investigation of optimal dose ertapenem in intermittent hemodialysis patients. Nephrol Dial Transplant. 2019;34:1766-72. doi:10.1093/ndt/gfy166
Canal C, Pellicer R, Facundo C, Gràcia-García S, Montañés-Bermúdez R, Ruiz-García C, et al. Tablas para la estimación del filtrado glomerular mediante la nueva ecuación CKD-EPI a partir de la concentración de creatinina sérica. Nefrología (Madr.). 2014;34(2):223-229. doi:10.3265/Nefrologia.pre2013.Dec.12226
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-45. doi:10.1038/clpt.1981.154
Bhattacharyya S, Darby RR, Raibagkar P, Gonzalez LN, Berkowitz AL. Antibiotic-associated encephalopathy. Neurology. 2016;86(10):963-71. doi:10.1212/WNL.0000000000002455
Fugate JE, Kalimullah EA, Hocker SE, Clark SL, Wijdicks EF, Rabinstein AA. Cefepime neurotoxicity in the intensive care unit: a cause of severe, underappreciated encephalopathy. Crit Care. 2013;17(6):R264. doi:10.1186/cc13094
Shahar S, Arimuthu DA, Mazlan SA. Ertapenem-induced neurotoxicity in an end-stage renal disease patient on intermittent haemodialysis: a case report. BMC Nephrol. 2022;23(1):360. doi:10.1186/s12882-022-02980-8
Wang C, Zhou Y, Zhou Y, Ye C. Ertapenem-induced neurotoxicity: a literature review of clinical characteristics and treatment outcomes. Infect Drug Resist. 2023;16:3649-58. doi:10.2147/IDR.S406852
Campany-Herrero D, Pau-Parra A, González-Moreno P, Vima-Bofarull J, Anguita-Domingo D, Montoro-Ronsano B. Ertapenem blood concentration: a retrospective cohort study to analyse risk of neurotoxicity. Br J Clin Pharmacol. 2023;89(9):2843-2850. doi:10.1111/bcp.15782
Danés I, Pérez E, Pigrau C, Gracia RM, Perelló M, Sueiras M, et al. A case series of confusional states and other neurotoxic effects caused by ertapenem. Br J Clin Pharmacol. 2021;87(4):2140-45. doi:10.1111/bcp.14582
Apodaca K, Baker J, Bin-Bilal H, Raskin Y, Quinn DK. Ertapenem-induced delirium: a case report and literature review. Psychosomatics. 2015;56(5):561-6. doi:10.1016/j.psym.2015.02.002
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ramón Rolando Cámara-Reyes, Eddie Giampiere Díaz-Carrión, Marco Antonio Zuñiga-Rosas, Erika Cecilia Agurto-Lescano
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors assign their rights to the RMH so that may disseminate the article through the means at their disposal. The journal will provide forms of affidavit of authorship and authorization for the publication of the article, which shall be submitted with the manuscript. Authors retain the right to share, copy, distribute, perform and publicly communicate their article, or part of it, mentioning the original publication in the journal.
