Nervous system seizures, carbapenems

Nervous system The carbapenems can cause seizures [SEDA-33, 491]. A 69-year-old man with diabetes and hypertension developed a glioblastoma, which was removed [4 j. About 1 month later, he developed skin and respiratory infections and was given imipenem. During the next 2 days his consciousness became impaired... 

The safety profile of the carbapenems is comparable to that of other beta-lactam antibiotics, in particular with regard to laboratory abnormalities, the most common ones being those related to liver function (3,4). In patients with pre-existing nervous system disease or who take dosages above the recommended limits (for example in renal impairment) seizures appear to be more common with imipenem + cilastatin. 

Carbapenems (imipenem more than meropenem) are believed to increase central nervous system excitation by inhibition of GABA binding to receptors. Combinations with other GABA-inhibiting drugs, such as theophylline or quinolones, have been reported to provoke seizures (59,60). 

Susceptibility fiictois The proconvulsant activity of the carbapenems, particularly imipenem, has limited their usefulness in patients at high risk of seizures, such as patients with nervous system infections, especially meningitis, chronic or acute nervous system damage, and more generally in patients with compromised rerud function and a reduced threshold for seizure activity. The risk of seizures due to carbapenems is increased by renal insufficiency... 

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