Ertapenem tedavisine bağlı gelişen deliryum ve tremor

Ertapeneme bağlı nörotoksik yan etkilerden nöbet sıklıkla bildirilmesine rağmen, halüsinasyon, dezoryantasyon, tremor gibi nöbet dışı yan etkiler nadiren bildirilmiştir. Bu yan etkiler ertapenem kullanılmasının devam etmesi durumunda hayatı tehdit edici boyutlara ulaşabildiği gibi, kesilmesi durumunda tamamen gerilemektedir. Altmış yaşında kadın hasta akut böbrek yetmezliği nedeniyle hemodiyalize girmiş, kan ve idrar kültüründe genişletilmiş spekrumlu beta laktamaz pozitif Escherichia coli üremesi nedeniyle ertapenem başlanmıştır. Ertapenem tedavisinin altıncı gününde ellerinde tremor ve sekizinci gününde halusinasyon, dezoryantasyon, saldırganlık, konuşma ve yürüme bozukluğu başlamış, tedavi kesildikten sonra 72 saat içinde tüm bulgular gerilemiştir. Ertapeneme bağlı nöbet dışı nörotoksisiteye dikkat çekmek amacıyla bu olgu bildirilmiştir.

Delirium and tremor associated with ertapenem treatment

Though seizures are the most commonly reported neurotoxic adverse effects of ertapenem, there are numerous other side effects including hallucinations, disorientation, and tremors which are hardly ever reported. These side effects can be life-threatening, in the case of continued use of ertapenem. However, these treatment-related side effects completely resolve with discontinuation of the treatment. A 60-year-old female patient underwent hemodialysis owing to acute kidney insufficiency. Ertapenem was used to treat the condition since cultures from blood and urine sample of the patient showed growth of extended-spectrum beta-lactamase positive Escherichia coli. It was seen that the patient experienced tremors in the hand on the sixth day of the treatment, and hallucinations, disorientation, aggression, impaired speech as well as gait disturbances on the eighth day. With the discontinuation of ertapenem treatment, all these symptoms disappeared within 72 hours. This paper emphasizes on the neurotoxicity other than seizures resulting from ertapenem.

PDF

___

1. Oo Y, Packham D, Yau W, Munckhof WJ. Ertapenem-associated psychosis and encephalopathy. Int Med J 2014:44(8);817-9.
2. Apodaca K, Baker, Bin-Bilal H, Raskin Y, Quinn DK. Ertapenem-induced delirium: A case report and literature review. Psychosomatics 2015:56(5);561-6.
3. Ribo FZ, Ribo AA. Ertapenem-induced neuropsychiatric symptoms in an elderly patient with chronic kidney disease resulting to a prescribing cascade. J Pharmacovigil 2014;2(6):152.
4. Duquaine S, Kitchell E, Tate T, Tannen RC, Wickremasinghe IM. Central nervous system toxicity associated with ertapenem use. Ann Pharmacother 2011:45(1):e6.
5. Veillette JJ, Van Epps P. Ertapenem-induced hallucinations and delirium in an elderly patient. Consult Pharm 2016:31(4);207- 14.
6. Lee KH, Ueng YF, Wu CW, Chou YC, Ng YY, Yang WC. The recommended dose of ertapenem poses a potential risk for central nervous system toxicity in haemodialysis patients-case reports and literature reviews. J Clin Pharm Ther 2015:40(2); 240-4.
7. Shea YF, Mok MYM, Cheng KC, Hon FKS, Chu LW. Delayed recovery from ertapenem induced encephalopathy: Case report and a possible mechanism. Int J Clin Pharm 2013:35(4);535-7.
8. Kong V, Beckert L, Awunor-Renner C. A case of beta lactam-induced visual hallucination. N Z Med J 2009;122(1298):76-7.
9. Kuchinskas S, Reger C. Tactile hallucinations as a side effect of ertapenem on an acute rehabilitation floor. Am J Phys Med Rehabil 2006;85(3):267.
10. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30(2):239-45.