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Chapter 63 – Méningites (QE) Sample Questions

1. A 52-year-old patient is admitted to hospital with bacterial meningitis and is started on empiric intravenous antibiotics. His medical history is significant for chronic kidney disease and a previous seizure disorder. While reviewing the treatment plan, the pharmacist is asked to assess which antimicrobial agent may increase the risk of seizures, particularly in patients with renal impairment. Which of the following antibiotics used in the treatment of meningitis is MOST associated with an increased risk of seizures?

A. Penicillin
B. Third-generation cephalosporins
C. Sulfonamides
D. Imipenem

Answer

Ans: D

Tips: Imipenem is well known to lower the seizure threshold, especially in patients with renal dysfunction or underlying CNS disorders. Accumulation of imipenem in renal impairment significantly increases seizure risk, making dose adjustment and careful monitoring essential.
• Penicillins → seizures only at very high doses or severe renal failure
• Third-generation cephalosporins → generally safe; seizures are rare
• Sulfonamides → not commonly associated with seizures
• Imipenem → highest seizure risk among β-lactams
Koda-Kimble states that “seizures are associated with high levels of β-lactams, particularly Penicillins and Imipenem. Therapeutic choices list seizures as a potential side-effect of high doses of Penicillin, Ampicillin, Ceftriaxone and Ceftazidime. Sulfonamides do not cause seizures but potential side-effects include GI, cholestatic hepatitis, exfoliative dermatitis (Stevens-Johnson Syndrome, bone (neutropenia, thrombocytopenia), kernicterus (in neonates).

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