At Grane Rx, we’re committed to providing the highest-quality post acute care pharmacy services. As part of that commitment, we share an ongoing series of pharmacy updates from our Chief Clinical Officer. This keeps you in the know on clinical topics related to long term care pharmacy and PACE pharmacy. Antibiotics are some of the most frequently used medications in inpatient and outpatient settings. Due to the extensive use and their tolerability, recognizing major possible side effects of these medications does not always occur. The biggest of these would be the toxic side effects on the central nervous system (CNS). The most common CNS side effects are seizures, delirium, confusion, personality changes and ototoxicity. If CNS effects occur and are due to antibiotic therapy, they will typically occur within days of starting treatment.
Common CNS Offenders Used in Post acute Care Pharmacy
The antibiotics that are the biggest offenders in post acute care pharmacy are fluoroquinolones such as ciprofloxacin or levofloxacin. Penicillins such as piperacillin and ampicillin make the list. Also, cephalosporins such as cefazolin, ceftazidime and cefepime are big offenders. Carbapenems such as imipenem and meropenem; and macrolides such as clarithromycin and erythromycin are also on the list. It’s important to determine whether the CNS effects are occurring due to the medication or due to other causes. These could be neurological conditions, electrolyte imbalances or the infection itself. [Tweet “Learn which antibiotics can negatively affect the central nervous system. #longtermcarepharmacy”]
Steps Post acute Care Pharmacy Providers Can Take to Prevent and Treat CNS Effects
Before dispensing a potentially neurotoxic medication, it’s important for long term care pharmacy providers to evaluate risk factors. These include extremes of age (young children and the elderly), impaired renal function, history of CNS disease and damage to the blood-brain barrier. Avoiding the use of potentially neurotoxic agents in these residents may not be possible. Post acute care pharmacy providers should be aware of which medications have these side effects. So they can suggest appropriate dosage adjustments and to develop monitoring plans for these residents.
If a resident does develop any CNS effects while on a potentially neurotoxic antibiotic such as ciprofloxacin, it is important to immediately discontinue the offending medication and replace it with an appropriate non-neurotoxic antibiotic. CNS effects due to antibiotics normally resolve within five days of stopping the medication. If a resident continues to experience neurotoxicity effects such as seizures despite stopping the offending medication, use anticonvulsants temporarily. If a resident continues to experience neurotoxicity effects due to impaired renal function, perform hemodialysis or hemofiltration for sufficient clearance of the medication.
Because of the potentially higher incidence of CNS adverse effects in the geriatric population, it is important to be vigilant. Fortunately, most CNS adverse effects are rare and reversible.
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