Cefepime-Induced Neurotoxicity in an Elderly Patient: A Case Report

Cefepime, a fourth-generation cephalosporin, may cause neurotoxicity, especially in patients with renal impairment. We report an 81-year-old man with chronic kidney disease (CKD) treated with intravenous cefepime for pneumonia. After five days, he developed acute confusion and reduced consciousness. Laboratory results showed no metabolic abnormalities and no microbial growth in blood cultures, and chest X-ray images improved. Cefepime-induced neurotoxicity (CIN) was suspected; the drug was discontinued and replaced with piperacillin-tazobactam. Neurological status recovered fully within 48 hours. This case underscores the need to recognize cefepime neurotoxicity in elderly patients with renal dysfunction, ensuring timely intervention through dose adjustment or discontinuation.