Search
- Antimicrobial medications can be associated with neurological adverse reactions.
- An individual’s risk is influenced by their age, weight, nutritional status, the medications they are taking concurrently, and pharmacological properties (dosage, half-life, CNS permeability).
- Encephalopathy
- Seen with beta-lactams, fluoroquinolones, clarithromycin, and sulfamethoxazole-trimethoprim.
- Most commonly with cefepime.
- Higher risk in elderly, renal dysfunction, and preexisting CNS disease.
- Seizures
- Beta-lactams block GABA receptors.
- Highest risk with cefepime and imipenem.
- Peripheral neuropathy
- Associated with metronidazole, fluoroquinolones, linezolid, chloramphenicol, and isoniazid.
- Most cases are dose dependent.
- Some cases are irreversible.
- Ototoxicity
- Aminoglycosides cause cochlear NMDA receptor excitotoxicity.
- Weakness
- Fluoroquinolones, macrolides, and aminoglycosides inhibit acetylcholine release and bind neuromuscular junction receptors.
- Should be avoided in myasthenia gravis and Lambert-Eaton syndrome.
- Movement disorders
- Tremors – sulfamethoxazole-trimethoprim
- Dyskinesia, dystonic reactions – fluoroquinolones, chloramphenicol
- Cerebellar syndrome – metronidazole, aminoglycosides
Bottom Line: Recognition of antibiotic associated neurotoxicity reduces unnecessary workup and serious adverse effects.
References
- Vo ML. Commonly used drugs for medical illness and the nervous system. Continuum (Minneap Minn) 2020;26(3, Neurology of Systemic Disease):716-731.
Follow me on Twitter @EM_NCC