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Published Online, 11 January 2005, www.theannals.com, DOI 10.1345/aph.1E421.
 The Annals of Pharmacotherapy: Vol. 39, No. 2, pp. 352-356. DOI 10.1345/aph.1E421
© 2005 Harvey Whitney Books Company.
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Ertapenem-Associated Seizures in a Peritoneal Dialysis Patient

Arnold H Seto, MD

Chief Medical Resident, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA

Jessica C Song, PharmD

Assistant Professor of Pharmacy Practice, School of Pharmacy, University of the Pacific, Stockton, CA; Pharmacy Practice Residency Coordinator, Department of Pharmacy Services, Santa Clara Valley Medical Center

Steven S Guest, MD

Medical Director, Peritoneal Dialysis Unit, Kaiser Permanente Santa Clara, San Jose, CA; Clinical Associate Professor of Medicine, School of Medicine, Stanford University, Stanford, CA

Reprints: Dr. Guest, Kaiser Permanente Santa Clara, The Permanente Medical Group, 900 S. Kiely Blvd., San Jose, CA 95051-5329, fax 408/236-5877, guestnest5{at}yahoo.com

OBJECTIVE: To report a case of a patient undergoing peritoneal dialysis who developed refractory seizures after 2 doses of ertapenem.

CASE SUMMARY: A 56-year-old white man with end-stage renal disease requiring continuous ambulatory peritoneal dialysis experienced 5 seizures following 2 doses of ertapenem 500 mg given intravenously. The first generalized tonic-clonic seizure occurred 16 hours after the second ertapenem dose and lasted 3 minutes. Three hours after his first seizure, the patient experienced 2 more seizures 15 minutes apart, lasting 3 minutes each. After suffering a fifth seizure, the patient became apneic and pulseless and was not resuscitated, as he had previously requested a "do not resuscitate" status.

DISCUSSION: Carbapenem treatment has been associated with simple partial, complex partial, and generalized tonic-clonic seizures, with generalized seizures representing the most frequently occurring type. Safety data from 7 published clinical trials of ertapenem revealed a seizure incidence of 0.18%. To our knowledge, there are no previously published reports of ertapenem neurotoxicity in patients undergoing peritoneal dialysis. Moreover, little information is available regarding the pharmacokinetics of carbapenems in end-stage renal disease. Ertapenem pharmacokinetics were not tested in any patients receiving peritoneal dialysis during published clinical trials.

CONCLUSIONS: Our patient experienced 5 seizures, possibly induced by ertapenem, as validated by the Naranjo probability scale. Clinicians administering ertapenem to patients undergoing peritoneal dialysis should use caution, as clinical experience with the agent is limited and pharmacokinetic data are lacking.

Key Words: carbapenem, end-stage renal disease, ertapenem, neurotoxicity, peritoneal dialysis

Published Online, January 11, 2005. www.theannals.com, DOI 10.1345/aph.1E421




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