Penicillin seizures with

These are structurally related to penicillins and are excreted predominantly by renal tubular secretion. The risk of seizures with imipenem is 0.2%. They are toxic to the proximal renal tubule cells. 

GI distress, drug fever (partial cross-allergenicity with penicillins), CNS effects, including seizures with imipenem in OD or renal dysfunction. 

Antibiotic carbapenem active against many aerobic and anaerobic bacteria, including penicillinase-producing organisms a bactericidal inhibitor of cell wall synthesis. Used with cilastatin (which inhibits metabolism by renal dehydropeptidases). Tox allergy (partial cross-reactivity with penicillins), seizures (overdose). Meropenem is similar but does not require cilastatin. 

Peniciiiins Penicillin 30 min 10 million units/d IV, or CSF > 5 mg/L Seizures with single high dose or chronic excessive doses in patients with renal dysfunction. 

Collins, R. C., 19786, Use of cortical circuits during focal penicillin seizures an autoradiographic study with [ " CJ-deoxyglucose, Brain Res. 150 487-501. 

Isolated seizures that are not epilepsy can be caused by stroke, central nervous system trauma, central nervous system infections, metabolic disturbances (e.g., hyponatremia and hypoglycemia), and hypoxia. If these underlying causes of seizures are not corrected, they may lead to the development of recurrent seizures I or epilepsy. Medications can also cause seizures. Some drugs that are commonly associated with seizures include tramadol, bupropion, theophylline, some antidepressants, some antipsy-chotics, amphetamines, cocaine, imipenem, lithium, excessive doses of penicillins or cephalosporins, and sympathomimetics or stimulants. 

CNS Penicillins have caused neurotoxicity (manifested as lethargy, neuromuscular irritability, hallucinations, convulsions, and seizures) when given in large IV doses, especially in patients with renal failure. 

A patient is being treated with the compound imipenem for penicillin-resistant pneumococcal infection and is responding well. After several days of treatment, the patient begins vomiting and has diarrhea. You observe a slight seizure at the same time. The infection is very severe, and you do not wish to terminate the imipenem but you fear that the adverse effects will make this a necessity. What do you do ... 

Imipenem-cilastatin is one of the drugs of first choice for the empirical therapy of many polymicrobial pulmonary, intraabdominal, and soft tissue infections. The notable adverse effect of imipenem-cilastatin is seizures affecting 1% of patients. Risk factors for seizures are old age, head trauma, previous seizure disorder, cerebrovascular accident, and renal failure. Among patients with a history of penicillin allergy, 10% are cross-sensitive to imipenem-cilastatin. 

The most common adverse effects of carbapenems—which tend to be more common with imipenem—are nausea, vomiting, diarrhea, skin rashes, and reactions at the infusion sites. Excessive levels of imipenem in patients with renal failure may lead to seizures. Meropenem, doripenem, and ertapenem are much less likely to cause seizures than imipenem. Patients allergic to penicillins may be allergic to carbapenems as well. 

High doses of penicillins, in the order of several million units/day of penicillin G, can produce myoclonic jerks, hyper-reflexia, seizures, or coma. Drowsiness and hallucinations can occur occasionally (18-20). Such reactions are due to a direct toxic effect and are more likely with high concentrations, as seen with intravenous administration (21,22) and with cardiopulmonary bypass in open-heart surgery (23,24). 

Adverse reactions Overall, the penicillins are well tolerated. The most common adverse effects are due to hypersensitivity reactions. Hypersensitivity reactions can be simply categorized as immediate reactions (type 1) or late reactions. Type 1 reactions are IgE mediated and are often associated with systemic manifestations such as diffuse erythema, pruritus, urticaria, angioedema, and bronchospasm. The most severe yet rare IgE-mediated side effect is anaphylaxis (0.05%). Type 1 reactions usually occur within 72 hr of administration. Late reactions usually occur 72 hr after drug administration. The most common late reactions include skin rashes characterized as maculopapular or morbilliform rashes. Rarely, nafcillin may cause neutropenia. Seizures in high doses, vaginal moniliasis, and Clostridium difficile infection also can occur with all penicillins... 

Adverse effects of imipenem-cilastatin include gastrointestinal distress, skin rash, and, at very high plasma levels, CNS toxicity (confusion, encephalopathy, seizures). There is partial cross-allergenicity with the penicillins. Meropenem is similar to imipenem except that it is not metabolized by renal dehydropeptidases and is less likely to cause seizures. 

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