Cefepime-Induced Delirium

Cefepime is a fourth-generation cephalosporin usually reserved to treat severe infections or those caused by multi-resistant microorganisms. Neurotoxicity is attributed to its ability to cross the blood-brain barrier and produce gamma-aminobutyric acid antagonism. Neurological symptoms may range from mild somnolence to seizures and coma. Our patient is an 88-year-old man who presented from a nursing home due to worsening pressure ulcers. After cefepime was started, he started developing worsening altered mental status and hallucinations. Cefepime was discontinued and his neurological symptoms improved shortly afterward. He was discharged to a long-term acute facility for antibiotic therapy where he recovered. Our case illustrates a commonly missed side effect of cefepime. Prompt recognition of this adverse effect is paramount to prevent disease progression and avoid permanent neurological damage.