Seizure aggravation by ampicillin/sulbactam in an elderly patient with status epilepticus
Dublin Core
Title
Seizure aggravation by ampicillin/sulbactam in an elderly patient with status epilepticus
Subject
Seizure aggravation, Antibiotic-associated encephalopathy, Ampicillin/sulbactam, Status epilepticus,
Continuous electroencephalogram monitoring, Critical care EEG, Density spectral array
Continuous electroencephalogram monitoring, Critical care EEG, Density spectral array
Description
Abstract
Background Ampicillin/sulbactam (ABPC/ SBT) is one of the most common β-lactam antibiotics for patients with
status epilepticus complicated with aspiration pneumonia. It is known that β-lactam antibiotics such as penicillin
aggravate epileptic seizures or status epilepticus. Here, we investigated whether ABPC/SBT aggravates seizures using
electroencephalography (EEG) monitoring.
Case presentation An 84-year-old male with status epilepticus who presented with a new onset of clonic seizures
mainly of his left side and underwent continuous video EEG was analyzed. He had been suffering from severe
ulcerative colitis and infectious enteritis, delirium, atrial fibrillation and deep venous thrombosis. His cerebrospinal
fluid analysis was unremarkable. Four days after starting levetiracetam, he had a cluster of seizures with impaired
consciousness, consistent with status epilepticus. We started fosphenytoin and phenobarbital. We also administered
ABPC/SBT twice a day, ten times in total, for aspiration pneumonia while monitoring the patient. He died twelve
days after the seizure onset. We analyzed the number and duration of seizures in two hours before and after starting
ABPC/SBT for each administration using EEG with trendgraph. After administration of ABPC/SBT, number of seizures
significantly increased from 3.2±4.7 to 7.3±9.7 (mean±SD, p=0.047, Wilcoxson’s signed-rank test) per 2 h. Duration
of seizures showed a tendency of increase from 199±275 to 406±536 s (p=0.079).
Conclusions In this elderly male patient with status epilepticus, administration of ABPC/SBT aggravated his seizures.
EEG monitoring using a trendgraph is useful for evaluation of seizure severity and for analysis of causative factors.
Keywords Seizure aggravation, Antibiotic-associated encephalopathy, Ampicillin/sulbactam, Status epilepticus,
Continuous electroencephalogram monitoring, Critical care EEG, Density spectral array
Background Ampicillin/sulbactam (ABPC/ SBT) is one of the most common β-lactam antibiotics for patients with
status epilepticus complicated with aspiration pneumonia. It is known that β-lactam antibiotics such as penicillin
aggravate epileptic seizures or status epilepticus. Here, we investigated whether ABPC/SBT aggravates seizures using
electroencephalography (EEG) monitoring.
Case presentation An 84-year-old male with status epilepticus who presented with a new onset of clonic seizures
mainly of his left side and underwent continuous video EEG was analyzed. He had been suffering from severe
ulcerative colitis and infectious enteritis, delirium, atrial fibrillation and deep venous thrombosis. His cerebrospinal
fluid analysis was unremarkable. Four days after starting levetiracetam, he had a cluster of seizures with impaired
consciousness, consistent with status epilepticus. We started fosphenytoin and phenobarbital. We also administered
ABPC/SBT twice a day, ten times in total, for aspiration pneumonia while monitoring the patient. He died twelve
days after the seizure onset. We analyzed the number and duration of seizures in two hours before and after starting
ABPC/SBT for each administration using EEG with trendgraph. After administration of ABPC/SBT, number of seizures
significantly increased from 3.2±4.7 to 7.3±9.7 (mean±SD, p=0.047, Wilcoxson’s signed-rank test) per 2 h. Duration
of seizures showed a tendency of increase from 199±275 to 406±536 s (p=0.079).
Conclusions In this elderly male patient with status epilepticus, administration of ABPC/SBT aggravated his seizures.
EEG monitoring using a trendgraph is useful for evaluation of seizure severity and for analysis of causative factors.
Keywords Seizure aggravation, Antibiotic-associated encephalopathy, Ampicillin/sulbactam, Status epilepticus,
Continuous electroencephalogram monitoring, Critical care EEG, Density spectral array
Creator
Kaoru Obata1,2, Masako Kinoshita3* , Akiyo Shinde1
and Toshihiko Suenaga1
and Toshihiko Suenaga1
Source
https://doi.org/10.1186/s12245-024-00793-0
Date
2025
Contributor
Peri Irawan
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Collection
Citation
Kaoru Obata1,2, Masako Kinoshita3* , Akiyo Shinde1
and Toshihiko Suenaga1, “Seizure aggravation by ampicillin/sulbactam in an elderly patient with status epilepticus,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12604.