The pharmacokinetics of oral metronidazole in patients with metronidazole‐induced encephalopathy undergoing maintenance hemodialysis

Potential Role of Therapeutic Drug Monitoring in Preventing Antibiotic-Induced Neuropsychiatric Disorders: A Narrative Review

BACKGROUND

Neuropsychiatric toxicity is a common adverse effect of antibiotics. Advanced age, renal insufficiency, high drug doses, and prolonged therapy are relevant risk factors, suggesting that this event might be caused due to the accumulation of antibiotics in the central nervous system. In this review, the authors aimed to evaluate the potential role of therapeutic drug monitoring in identifying patients at risk of antibiotic-induced neuropsychiatric toxicity.

METHODS

A MEDLINE PubMed search was conducted for articles published between January 1990 and December 2024, matching the terms "pharmacokinetics" or "therapeutic drug monitoring" with "antibiotics" (including individual drug classes) and "neurotoxicity" (including synonyms). Additional studies were identified from the reference lists of retrieved articles.

RESULTS

Significant associations have been reported between plasma concentrations of some beta-lactam antibiotics (ceftazidime, cefepime, piperacillin, and meropenem) or linezolid and drug-induced central nervous system adverse events (such as seizures, encephalopathy, peripheral neuropathy, and optic neuropathy). Safety thresholds of plasma concentrations have been proposed for these drugs.

CONCLUSIONS

Consistent data on the associations between plasma drug concentrations and neuropsychiatric disorders are available only for some antibiotics, whereas for others, there are few and often inconsistent data, hindering the establishment of therapeutic drug monitoring-based safety thresholds for these antibiotics.

Drugs with a negative impact on cognitive functions (part 3): antibacterial agents in patients with chronic kidney disease

The relationship between chronic kidney disease (CKD) and cognitive function has received increased attention in recent years. Antibacterial agents (ABs) represent a critical component of therapy regimens in patients with CKD due to increased susceptibility to infections. Following our reviewing work on the neurocognitive impact of long-term medications in patients with CKD, we propose to focus on AB-induced direct and indirect consequences on cognitive function. Patients with CKD are predisposed to adverse drug reactions (ADRs) due to altered drug pharmacokinetics, glomerular filtration decline, and the potential disruption of the blood-brain barrier. ABs have been identified as a major cause of ADRs in vulnerable patient populations. This review examines the direct neurotoxic effects of AB classes (e.g. beta-lactams, fluoroquinolones, aminoglycosides, and metronidazole) on the central nervous system (CNS) in patients with CKD. We will mainly focus on the acute effects on the CNS associated with AB since they are the most extensively studied effects in CKD patients. Moreover, the review describes the modulation of the gut microbiota by ABs, potentially influencing CNS symptoms. The intricate brain-gut-kidney axis emerges as a pivotal focus, revealing the interplay between microbiota alterations induced by ABs and CNS manifestations in patients with CKD. The prevalence of antibiotic-associated encephalopathy in patients with CKD undergoing intravenous AB therapy supports the use of therapeutic drug monitoring for ABs to reduce the number and seriousness of ADRs in this patient population. In conclusion, elucidating AB-induced cognitive effects in patients with CKD demands a comprehensive understanding and tailored therapeutic strategies that account for altered pharmacokinetics and the brain-gut-kidney axis.