Uncommon reaction to a common prescription

Khodakaram, Kaveh; Barmano, Neshro

doi:10.1016/s0140-6736(11)60996-3

Cited by 5 publications

(2 citation statements)

References 5 publications

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“…A dose-related effect has been suggested as the vast majority of reported cases of metronidazole-induced encephalopathy involve patients on high cumulative doses of metronidazole 15. However, a few reports describe patients who have developed symptoms after receiving low cumulative doses of metronidazole16 (and including our report), leading to the supposition that a standard treatment course of metronidazole can trigger metronidazole-induced encephalopathy.

Learning points

Metronidazole-induced encephalopathy is a rare adverse reaction to a widely prescribed medication.

Consider drug toxicity in the differential diagnosis of adult-onset acute cerebellar ataxia.

Metronidazole-induced encephalopathy is a completely reversible condition.

…”

Section: Discussionmentioning

confidence: 72%

Walking unsteadily: a case of acute cerebellar ataxia

et al. 2013

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Acute cerebellar ataxia is an infrequent neurological syndrome in adults especially if complicated by additional neurological deficits. We report the case of a 69-year-old woman who presented with sudden onset of left facial droop, dizziness, slurred speech and impaired balance. Her medical history included paroxysmal atrial fibrillation and a sigmoid diverticular abscess treated with ciprofloxacin and metronidazole. Cranial computed tomographic angiography and MRI showed no signs of acute ischaemia or haemorrhage but demonstrated symmetrically distributed lesions in the cerebellar dentate nuclei. A diagnosis of metronidazole-induced encephalopathy was suspected. Metronidazole was stopped and the patient completely recovered. Metronidazole is a commonly prescribed medication. Clinicians should be aware of the clinical and radiological presentation of metronidazole-induced encephalopathy so that this serious but completely reversible condition can be promptly diagnosed.

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Learning points

Metronidazole-induced encephalopathy is a rare adverse reaction to a widely prescribed medication.

Consider drug toxicity in the differential diagnosis of adult-onset acute cerebellar ataxia.

Metronidazole-induced encephalopathy is a completely reversible condition.

…”

Section: Discussionmentioning

confidence: 72%

Walking unsteadily: a case of acute cerebellar ataxia

et al. 2013

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“…Common prescriptions can lead to uncommon reactions, such as Central Nervous System (CNS) Adverse Drug Reactions (ADRs) [ 1 ]. Antibiotics are still an under-recognized etiology compared to their high consumption in hospitals; about 50% of hospitalized patients receive at least one antibiotic during their hospital stay [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Serious Neurological Adverse Events of Ceftriaxone

et al. 2021

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We described ceftriaxone-induced CNS adverse events through the largest case series of Adverse Drug Reactions (ADRs) reports, from 1995 to 2017, using the French Pharmacovigilance Database. In total, 152 cases of serious CNS ADRs were analyzed; 112 patients were hospitalized or had a prolonged hospitalization (73.7%), 12 dead (7.9%) and 16 exhibited life-threatening ADRs (10.5%). The median age was 74.5 years, mainly women (55.3%), with a median creatinine clearance of 35 mL/min. Patients mainly exhibited convulsions, status epilepticus, myoclonia (n = 75, 49.3%), encephalopathy (n = 45, 29.6%), confused state (n = 34, 22.4%) and hallucinations (n = 16, 10.5%). The median time of onset was 4 days, and the median duration was 4.5 days. The mean daily dose was 1.7 g mainly through an intravenous route (n = 106, 69.7%), and three patients received doses above maximal dose of Summary of Product Characteristics. Ceftriaxone plasma concentrations were recorded for 19 patients (12.5%), and 8 were above the toxicity threshold. Electroencephalograms (EEG) performed for 32.9% of the patients (n = 50) were abnormal for 74% (n = 37). We described the world’s biggest case series of ceftriaxone-induced serious CNS ADRs. Explorations (plasma concentrations, EEG) are contributive to confirm the ceftriaxone toxicity-induced. Clinicians may be cautious with the use of ceftriaxone, especially in the older age or renal impairment population.

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