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Table 1 Summary of selected reports of seizure adverse events in patients receiving imipenem or meropenem

From: Clinical review: Balancing the therapeutic, safety, and economic issues underlying effective antipseudomonal carbapenem use

Study Patient population Dosage Seizure incidence Notes
Imipenem     
   Winston et al. 1984 [24] 35 patients with infections from imipenem-susceptible organisms 4 g/day (23 patients); <4 g/day (12 patients) None  
   Calandra et al. 1985 [17] First 2,516 patients treated; most had significant background disorders <2 g/day, 32 percent; 2 g/day, 44 percent; >2 g/day, 24 percent 1.5 percent (37/2,516) all episodes; 0.24 percent (6/2,516) imipenem related High rates of central nervous system disorders in patients with seizures
   Winston et al. 1988 [25] 29 febrile granulocytopenic patients 1 g q6h 10.3 percent (3/29) Versus 0 percent (0/58) treated with 2 β-lactams
   Eng et al. 1989 [4] First 22 patients treated Varied (500 mg q12h to 1 g q6h) 22.7 percent (5/22)  
   Rolston et al. 1992 [22] 371 febrile neutropenic cancer patients 12.5 mg/kg q6h 1.5 percent (3/196) imipenem + vancomycin; 3.4 percent (6/175) imipenem + amikacin 1 g qh6 for an 80 kg patient
   Norrby et al. 1993 [19] 197 patients with severe nosocomial infections 500 mg q6h adjusted for renal dysfunction 0.5 percent (1/197) Versus 0 percent (0/196) treated with ceftazidime
   Raad et al. 1996 [21] 198 febrile neutropenic cancer patients 500 mg q6h 0.5 percent (1/198) imipenem + vancomycin Versus 0 percent (0/192) treated with aztreonam + vancomycin
   Karadeniz et al. 2000 [18] 82 pediatric patients with malignancies 50 mg/kg/day in 3 doses 3.6 percent (3/82)  
   Koppel et al. 2001 [3] 98 patients Max. 2 g/day 4.0/1,000 patient-days (on imipenem); 3.9/1,000 patient-days (not on imipenem) No increase in risk due to imipenem
   Winston et al. 2001 [94] 541 febrile granulocyto-penic patients 500 mg q6h 2 percent 0 percent for clinafloxacin (200 mg every 12 h); P = 0.06
Meropenem     
   Sieger et al. 1997 [96] 104 patients with noso-comial lower respiratory tract infections 1 g q8h 2.9 percent (3/104) all episodes; 0 percent meropenem related  
   Norrby et al. 1999 [29] 4,872 patients in multiple trials 0.5 to 1 g q8h Meropenem related: 0.08 percent (patients without meningitis); 0 percent (patients with meningitis)