Open AccessCeftriaxone-induced Encephalopathy: A Pharmacokinetic Approach
Author(s) -
Laurent Jadot,
Aurelie Judong,
Jean-Luc Canivet,
Noël Lorenzo Villalba,
Pierre Damas
Publication year - 2021
Publication title -
european journal of case reports in internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.125
H-Index - 1
ISSN - 2284-2594
DOI - 10.12890/2021_003011
Subject(s) - ceftriaxone , medicine , neurotoxicity , cerebrospinal fluid , cephalosporin , pharmacokinetics , encephalopathy , efflux , pharmacology , antibiotics , plasma concentration , blood–brain barrier , anesthesia , gastroenterology , central nervous system , toxicity , chemistry , biochemistry
We report a case of ceftriaxone-induced encephalopathy correlated with high cerebrospinal fluid concentration. Neurotoxicity of cephalosporin is increasingly reported, especially regarding fourth-generation cephalosporins. The factors influencing the corticospinal fluid (CSF) concentration are plasma concentration, liposolubility, ionization, molecular weight, protein binding and efflux. In our patient, high levels of ceftriaxone (27.9 mg/l) were found in the CSF. β-lactam associated neurotoxicity is mainly related to similarities between GABA and β-lactam ring. Because of disparate CSF/plasma ratio and blood-brain barrier efflux among patients, plasmatic drug monitoring probably cannot be used as a surrogate of CSF concentration. This is, as we know, the first case of described ceftriaxone-induced encephalopathy associated with an objective excessive cerebrospinal concentration.