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Ceftriaxone-Induced Encephalopathy — SCE Neurology MCQ

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HardCNS InfectionsCeftriaxone-Induced EncephalopathySCE Neurology

A 78-year-old with acute kidney injury develops aphasia, myoclonus and reduced consciousness on day 5 of cefepime. EEG shows generalised periodic discharges with triphasic morphology; glucose, ammonia and cranial imaging are non-explanatory. What is the most appropriate immediate drug-related action?

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Correct answer: C — Stop cefepime and replace it with renal-adjusted antimicrobial cover

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

A leaves the accumulating neurotoxin in place and treats a manifestation only. B does not address renal dosing or the causal exposure. C is correct: renal dysfunction, delayed encephalopathy, myoclonus and triphasic or epileptiform EEG patterns strongly indicate cefepime neurotoxicity; withdrawal is central and dialysis can accelerate clearance in severe cases. D uses the wrong antidote mechanism. E creates an avoidable delay.

Reference: Cefepime-induced neurotoxicity: systematic review: https://pmc.ncbi.nlm.nih.gov/articles/PMC5686900/