[The risk of epileptic seizures during antibiotic therapy].

Numerous antibiotics may trigger epileptic seizures or status epilepticus by decreasing inhibitory transmission in the brain, thus lowering the seizure threshold. The most potent seizurogenic effect is exerted by penicillins, cephalosporins, fluorochinolons and carbapenems. Predisposing factors that facilitate development of epileptic seizures in the course of antibiotic therapy comprise all conditions accompanied by damage to the blood-brain barrier (including cerebral trauma and encephalitis), a high dose of an antibiotic or lack of adequate dose adjustment in patients with renal failure. A particularly dangerous and difficult to diagnose complication is nonconvulsive status epilepticus in patients treated with cephalosporins. For this reason, in case the patient presents with alterations of consciousness in the course of cephalosporin therapy, an EEG test should be performed. Some antibiotics, such as carbapenems, macrolides and antitubercular medications enter into pharmacokinetic interactions with antiepileptic agents, causing a decrease or increase in the plasma concentration of the latter and in consequence lead to possible epileptic seizures or drug-associated neurotoxicity. In patients with risk of epileptic seizures or with diagnosed epilepsy, one should select an antibiotic with a low proconvulsive potential and administer it in an adequately adjusted dose, especially in individuals with renal failure. Employing antibiotics interacting with antiepileptic medications with which the patient is treated should be avoided.