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Antibiotics are commonly prescribed medications in the inpatient and outpatient setting and it's important to recognize #AdverseEvents, including idiosyncratic reactions, such as #encephalopathy.

2/
Antibitiotics associated with #Encephalopathy:
- Beta lactams
- #Cephalosporins (#Cefepime is the most common,
Ceftazidime)
- Imipenem
- #Penicillin procaine
- Fluoroquinolones
- Macrolides (clarithromycin)
- TMP-SMX
- #Metronidazole
- Isoniazid

3/
#Psychosis can be found in almost 50% of cases, most commonly associated with:
- Sulfonamides
- Quinolones
- Macrolides
- Penicillin procaine

4/
#Seizures can be present and are commonly associated with #penicillin and #cephalosporins, but can also be present with quinolones, macrolides and #metronidazole

5/
#Myoclonus usually present with #Penicillin and #cephalosporins

In #Encephalopathy (that can include #seizures) + Acute #cerebellar syndrome, look for chronic/long-term use of #metronidazole. Usually accompanied with an abnormal #BrainMRI.

6/
MRI brain T2 FLAIR hyperintensities are most commonly seen in dentate nucleus of the #cerebellum, but can also involve the #brainstem and #splenium of the corpus callosum.

radiopaedia.org/cases/metronid…

7/
Language dysfunction (#aphasia) has also been described with #Cefepime.

In addition: #peripheralneuropathy has been associated with #metronidazole, #fluoroquinolones, #Linezolid, #chloramphenicol, #Isoniazid and #nitrofurantoin.

8/
Important #lab investigations:
- EEG (usually abnormal with penicillin and cephalosporins)
- MRI brain (normal with all antibiotics, except metronidazole)
- Renal function tests
- Liver function tests

9/
Most common #EEG abnormality: slowing and Geneneralized periodic discharges with #triphasic morphology.
#Epileptiform discharges or seizures can be present with #penicillin, #cephalosporins, #quinolones.
Don-t forget non-convulsive status!

Image from: e-jnc.org/upload/pdf/jnc…
10/
Lastly, onset of encephalopathy usually occurs within 5 days of starting the antibiotic, except for #metronidazole (3 weeks) and #isoniazid (weeks-months).

Early identification of possible antibiotic involved and discontinuation will improve patient outcomes.

11/
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