Title: Neurological Adverse Reactions with Antimicrobials <br/>Author: WanTsu Wendy Chang<br/><a href='http://umem.org/profiles/faculty/1322/'>[Click to email author]</a><hr/><ul>   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Antimicrobial medications can be associated with neurological adverse reactions. </span></span></li>   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">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). </span></span></li>   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Encephalopathy </span></span>    <ul>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Seen with beta-lactams, fluoroquinolones, clarithromycin, and sulfamethoxazole-trimethoprim. </span></span></li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Most commonly with cefepime. </span></span></span></span></li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Higher risk in elderly, renal dysfunction, and preexisting CNS disease. </span></span></span></span></span></span></li>    </ul>   </li>   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Seizures </span></span>    <ul>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Beta-lactams block GABA receptors. </span></span></li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Highest risk with cefepime and imipenem. </span></span></span></span></li>    </ul>   </li>   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Peripheral neuropathy </span></span>    <ul>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Associated with metronidazole, fluoroquinolones, linezolid, chloramphenicol, and isoniazid. </span></span></li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Most cases are dose dependent. </span></span></li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Some cases are irreversible. </span></span></li>    </ul>   </li>   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Ototoxicity </span></span>    <ul>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Aminoglycosides cause cochlear NMDA receptor excitotoxicity. </span></span></li>    </ul>   </li>   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Weakness </span></span>    <ul>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Fluoroquinolones, macrolides, and aminoglycosides inhibit acetylcholine release and bind neuromuscular junction receptors. </span></span></li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Should be avoided in myasthenia gravis and Lambert-Eaton syndrome. </span></span></li>    </ul>   </li>   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Movement disorders </span></span>    <ul>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Tremors – sulfamethoxazole-trimethoprim </span></span></li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Dyskinesia, dystonic reactions – fluoroquinolones, chloramphenicol </span></span></span></span></li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Cerebellar syndrome – metronidazole, aminoglycosides </span></span></span></span></span></span></li>    </ul>   </li>  </ul>  <p>   <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><strong><u>Bottom Line</u>:</strong> Recognition of antibiotic associated neurotoxicity reduces unnecessary workup and serious adverse effects. </span></span></p>  <fieldset><legend>References</legend>

                <ul>   <li>    <span style="font-size: 14px;"><span style="font-family: arial, helvetica, sans-serif;">Vo ML. Commonly used drugs for medical illness and the nervous system. <em>Continuum (Minneap Minn)</em> 2020;26(3, Neurology of Systemic Disease):716-731. </span></span></li>  </ul>  <p style="text-align: center;">   <em><strong><span style="font-size: 14px;"><span style="font-family: arial, helvetica, sans-serif;">Follow me on Twitter @EM_NCC</span></span></strong></em></p>  </fieldset>