Majallah-i Dānishgāh-i ̒Ulūm-i Pizishkī-i Bābul (Jun 2008)
A CASE REPORT OF IMIPENEM-INDUCED SEIZURE DUE TO DRUG INTERACTION AND ACCIDENTAL HIGH DOSE
Abstract
BACKGROUND AND OBJECTIVE: Although most antibiotics are safe for central nervous system (CNS) and their neurotoxicity is infrequent, beta-lactam antibiotics (especially imipenem) are most commonly antibacterial agents associated with CNS adverse events such as seizure. In this report a case of important drug interaction following imipenem administration was introduced.CASE: A 66 year old man was presented with chief complaint of abdominal pain and difficulty to eat food. After diagnosis of cardia cancer (adenocarcinoma), the patient underwent laparotomy and total gastrectomy and transported to the intensive care unit (ICU). Due to respiratory infection, imipenem (1.5 g per 6 hrs) and ciprofloxacin (750 mg per 8 hrs) ordered and the patient experienced a resistant seizure after the third doses of imipenem that was not improved with diazepam and phenytoin and controlled after using thiopental. After controlling seizure, administration of phenytoin with maintenance dose continued and the patient did not regain consciousness degree that he had before the occurrence of seizure. Two week later, the patient died due to septic shock and severe physiological instability while the seizure was one of the main causes of his complication and mortality.CONCLUSION: Unintentional using of higher doses of imipenem and ciprofloxacin (4g and 1500mg, respectively and co-administration of them in critically ill patient produced severe seizure. With determination of assistant factors (high age and decreased renal function) and removing of risk factors (high dose and co-administration of two or more suspected drugs), these dangerous adverse reactions can be prevented.
