1

Sutter et al.

Table e-2. Publications regarding penicillins and seizures or status epilepticus

Reference / Year / Design (AAN Class of evidence) / Number of patients / Dosage / Contributing factors other than antibiotics / Reported symptomatic seizure(s)
Penicillin G or oxacillin
Boston Collaborative Drug Surveillance Program 1 / 1972 / Multicenter observational study
(Class IV) / 12’617 patients / 20-24 million units penicillin G per day / A high proportion of patients with renal insufficiency (% not provided) / Drug-related seizures occurred in 3,2 per 1000 patients
Weinstein et al. 2 / 1964 / Prospective study
(Class IV) / 17 patients / 10-80 million units penicillin G per day / All with bacteremia
2 with renal insufficiency
1 with braintumor
1 with systemic Lupus erythematosus / Repetitive generalized seizures in 1 patient
Lerner et al. 3 / 1967 / Case series
(Class IV) / 10 patients / 3-80 million units penicillin G per day / 3 with bacterial meningitis / Repetitive generalized convulsive seizures (in 50%) and myoclonic (in 80%)
Bloomer et al. 4 / 1967 / Case series
(Class IV) / 4 patients / 30-60 million units penicillin G per day / 2 with renal insufficiency
1 with cerebral thrombosis
1 with alcoholism-related chronic brain syndrome / Myoclonus and generalized convulsive seizures
Trunet et al. 5 / 1982 / Case series
(Class IV) / 5 patients / Not provided / All with renal insufficiency / Seizures in 2 patients
Conway et al. 6 / 1968 / Case reports
(Class IV) / 3 patients / 50-100 million units penicillin G per day / 1 with renal insufficiency / Generalized convulsive seizures
Kurtzman et al. 7 / 1970 / Case report
(Class IV) / 1 patient / 24 million units penicillin G per day / With renal insufficiency / Generalized convulsive seizures
Lavy et al. 8 / 1970 / Case report
(Class IV) / 1 patient / 70 million units penicillin G per day / With sepsis / Repetitive tonic-clonic seizures
Oldstone et al. 9 / 1966 / Case report
(Class IV) / 1 patient / 30 million units penicillin G per day / None / Repetitive focal motor seizures which
generalized
Amoxicillin/clavulanic acid
No report or studies
Piperacillin/tazobactam
Bassilios et al. 10 / 2002 / Case report
(Class IV) / 1 patient / 8g/1g per day / With renal insufficiency / Repetitive generalized tonic-clonic seizure
Lin et al. 11 / 2007 / Case report
(Class IV) / 1 patient / 8g/1g per day / With end-stage renal disease / Two generalized tonic-clonic seizures
Fernandez-Torre et al. 12 / 2010 / Case report
(Class IV) / 1 patient / 12g/1.5g per day / With sepsis / Nonconvulsive SE
Saito et al. 13 / 2008 / Case report
(Class IV) / 1 patient / 2g piperacillin per day / Tardive seizures after bitemporal electroconvulsive therapy / Generalized tonic-clonic seizure

AAN = American Academy of Neurology; SE = status epilepticus

References

1.Drug-induced convulsions. Report from Boston Collaborative Drug Surveillance Program. Lancet 1972;2:677-679.

2.Weinstein L, Lerner PI, Chew WH. Clinical and bacteriologic studies of the effect of "massive" doses of penicillin G on infections caused by gram-negative bacilli. N Engl J Med 1964;271:525-533.

3.Lerner PI, Smith H, Weinstein L. Penicillin neurotoxicity. Ann N Y Acad Sci 1967;145:310-318.

4.Bloomer HA, Barton LJ, Maddock RK, Jr. Penicillin-induced encephalopathy in uremic patients. JAMA 1967;200:121-123.

5.Trunet P, Bouvier AM, Otterbein G, Lepresle E, Lhoste F, Rapin M. Penicillin-induced encephalopathy. Nouv Presse Med 1982;11:1781-1784.

6.Conway N, Beck E, Somerville J. Penicillin encephalopathy. Postgrad Med J 1968;44:891-897.

7.Kurtzman NA, Rogers PW, Harter HR. Neurotoxic reaction to penicillin and carbenicillin. JAMA 1970;214:1320-1321.

8.Lavy S, Stein H. Convulsions in septicemic patients treated by penicillin. The value of electroencephalograph examination. Arch Surg 1970;100:225-228.

9.Oldstone MB, Nelson E. Central nervous system manifestations of penicillin toxicity in man. Neurology 1966;16:693-700.

10.Bassilios N, Restoux A, Vincent F, Rondeau E, Sraer JD. Piperacillin/Tazobactam inducing seizures in a hemodialysed patient. Clin Nephrol 2002;58:327-328.

11.Lin CS, Cheng CJ, Chou CH, Lin SH. Piperacillin/tazobactam-induced seizure rapidly reversed by high flux hemodialysis in a patient on peritoneal dialysis. Am J Med Sci 2007;333:181-184.

12.Fernandez-Torre JL, Santos-Sanchez C, Pelayo AL. De novo generalised non-convulsive status epilepticus triggered by piperacillin/tazobactam. Seizure 2010;19:529-530.

13.Saito T, Nakamura M, Watari M, Isse K. Tardive seizure and antibiotics: case reports and review of the literature. J ECT 2008;24:275-276.