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Beta-Lactam Neurotoxicity — SCE Infectious Diseases MCQ

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ModerateAntimicrobial StewardshipBeta-Lactam NeurotoxicitySCE Infectious Diseases

A 55-year-old man with COPD is admitted with a severe infective exacerbation. He is started on IV Piperacillin/Tazobactam. On day 3, he develops a generalised tonic-clonic seizure. He has no prior seizure history. Blood tests show creatinine 190 µmol/L (baseline 85). What is the most likely cause?

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Correct answer: B — Beta-lactam neurotoxicity (seizure) in the context of accumulation due to acute kidney injury — dose reduction or switch is required

All beta-lactam antibiotics (particularly Penicillins, Cephalosporins, and Carbapenems — especially Imipenem) can cause neurotoxicity (seizures, encephalopathy, myoclonus) through GABA-A receptor antagonism. The risk is increased with: renal impairment (drug accumulation), high doses, elderly patients, and pre-existing CNS disease. Piperacillin/Tazobactam is renally excreted and must be dose-reduced in AKI. The seizure should prompt: checking drug levels (if available), dose reduction, consideration of switching to a less neurotoxic agent, and excluding other causes.

Reference: BNF 2024 – Piperacillin/Tazobactam; BSAC 2023 – Beta-lactam neurotoxicity