Seizure Activity with Imipenem Therapy: Incidence and Risk Factors

Two elderly patients with a history of either cerebral vascular accident (CVA) or head trauma and no evidence of renal disease developed seizures while receiving maximum doses of imipenem/cilastatin. Neither patient had reported previous seizures or seizure-like activity nor was receiving anticonvulsant agents. All seizures were controlled with therapeutic doses of phenytoin. Both patients had received maximum doses of other beta-lactam antibiotics without evidence of seizure activity.

PRELIMINARY DATA on adverse clinical experiences with imipenem/cilastatin revealed a low frequency of drug-related seizures similar to that with beta-lactam antibiotics. These data included patients with predisposing factors such as a prior history of seizures, central nervous system neoplasms, recent head trauma, and stroke.¹ Since the release of this antibiotic, several cases of imipenem-induced seizures have been reported.^2–5 In some instances, the patients were elderly and had mild renal impairment. In other cases, the patients had no overt evidence of renal disease. We report two cases of seizures, both of which occurred in elderly patients who had no overt evidence of renal impairment but had a prior history of central nervous system injury.