Non-convulsive epileptic status after administration of cefepime in patients with advanced chronic renal failure

Fever is one of the most frequent causes of hospital admission in patients with end-stage renal disease. Lack of an identified source of infection and /or lack of clinical response to the first empirical antibiotic treatment f avour the use of broader spectrum antibiotics. The availability of fourth-g eneration cephalosporins (e.g. cefepime) and the increasing incidence of ba cterial resistances to classical antibiotics has increased their use in the clinical practice. We present two cases of non-convulsive status epilepticus in patients with advanced chronic renal failure who received cefepime at doses corrected for the degree of renal function according to the manufacturer's instrument as . The clinical symptoms included shouthough, processes, disorientation, los s of attention, and the later appearance of myoclonus. In both cases the el ectroencephalogram (EEG) was compatible with non-convulsive epileptic statu s. Alter cefepime withdrawal there was a clinical remission of symptoms and normalization of the EEG. It is concluded that cefepime treatment can induce a non-convulsive epilept ic status in patients with advanced chronic renal failure. Pharmacokinetic studies are urgently needed to clearly define the appropriate dose of cefep ime in patients with advanced chronic renal failure.