Carbapenem associated seizure in a severe melioidosis patient: A case report

The use of carbapenems has been associated with increased risk of seizure with imipenem having a higher propensity to induce seizure as compared to meropenem. As there is limited report on the cross-reactivity between these two agents, clinicians may choose to switch the antibiotic regimen to meropenem whenever an imipenem associated seizure is suspected. We described a 67-year-old woman who was admitted to the intensive care unit due to severe melioidosis. She experienced an episode of myoclonus jerks following two doses of imipenem 500 mg given intravenously at 12 hour interval. Two hours after her first seizure, the patient experienced two more myoclonus jerks which were two hours apart of each other. Imipenem was then discontinued and meropenem 1 g stat and followed by 500 mg every 12 hourly was given intravenously. However, patient continued to experience myoclonus jerks with the first episode occurring four hours after the initiation of meropenem. Phenytoin 100 mg every 8 hourly was given intravenously for the management of seizure. However, the frequency of myoclonus jerks increased to a total of 14 episodes on the next day. The phenytoin therapy was subsequently substituted with intravenous sodium valproate 750 mg stat followed by 400 mg every 12 hourly. With this change in treatment, patient’s seizure was resolved. The present case showed the possibility of cross-reactivity in neurotoxicity which occurred across the use of imipenem and meropenem.