既往研究显示抗生素常与癫痫有关。瑞典学者近期系统回顾了所有类别抗生素与癫痫相关性的当前证据，结果表明，抗生素和系统性癫痫的相关性证据为低至极低级别(III–IV级证据)。尽管如此，许多报告指出一些抗生素可增加系统性癫痫风险，尤其是对合并有肾功能障碍、脑损伤和癫痫的患者使用青霉素、第四代头孢菌素、亚胺培南和环丙沙星时。特别易感人群患者使用这类抗生素时，提倡应密切监测其血浆水平。由于与头孢菌素相关的大多数癫痫是非惊厥性的，因此应在转变意识水平患者中考虑持续脑电图(EEG)监测。相关文章近期发表于《神经病学》(Neurology.)杂志。

        研究纳入了包括25712例患者、25类不同抗生素的143篇文章。抗生素相关系统性癫痫的证据级别为低至极低，主要是源于有关β内酰胺类，尤其是青霉素类和第四代头孢菌素类，以及碳青霉烯类(主要是亚胺培南)的研究。这些药物均以大剂量使用或在合并肾功能障碍、大脑损伤或已知癫痫患者中应用。氟喹诺酮类抗生素环丙沙星相关的系统性癫痫证据仅是病例报告和案例分析，大多数报告为在伴肾功能障碍、精神疾病、既往癫痫患者中使用该药，或患者同时使用了茶碱类药物。

        译者注：第四代头孢菌素有头孢匹罗、头孢吡肟、头孢唑兰和头孢瑟利。

        英文原文

Seizures as adverse events of antibiotic drugs
A systematic review
1. Raoul Sutter, MD,
2. Stephan Rüegg, MD and
3. Sarah Tschudin-Sutter, MD, MSc
1. From the Clinic for Intensive Care Medicine (R.S.), the Division of Clinical Neurophysiology, Department of Neurology (R.S., S.R.), and the Division of Infectious Diseases and Hospital Epidemiology (S.T.-S.), University Hospital Basel, Switzerland.
1. Correspondence to Dr. Sutter: raoul.sutter{at}usb.ch
ABSTRACT
Objective: Antibiotic drugs are commonly associated with seizures. Tailoring antibiotics to the individual risk for seizures is challenged as avoidance of certain antibiotic classes may no longer be possible due to the emergence of resistant bacteria. We performed a systematic review regarding the current evidence for seizures associated with all antibiotic classes, their underlying mechanisms, and predisposing factors.
Methods: The medical search engine PubMed was systematically screened to identify articles in English published between 1960 and 2013. All study designs were considered and evidence was assessed.
Results: We included 143 articles involving 25,712 patients and 25 different antibiotics. Evidence for antibiotic-related symptomatic seizures is low to very low, mainly deriving from studies regarding β-lactams, especially unsubstituted penicillins and fourth-generation cephalosporins, as well as carbapenems, mainly imipenem, all administered in high doses or in patients with renal dysfunction, brain lesions, or known epilepsy. Evidence regarding symptomatic seizures from fluoroquinolones only relies on case reports and case series with most reports for ciprofloxacin in patients with renal dysfunction, mental disorders, prior seizures, or coadministered theophylline.
Conclusions: Evidence for an association between antibiotic drugs and symptomatic seizures is low to very low (evidence Class III–IV). Despite this, numerous reports point to an increased risk for symptomatic seizures especially of unsubstituted penicillins, fourth-generation cephalosporins, imipenem, and ciprofloxacin in combination with renal dysfunction, brain lesions, and epilepsy. During administration of such antibiotics in patients with particular predispositions, close monitoring of serum levels is advocated. As most seizures associated with cephalosporins are nonconvulsive, continuous EEG should be considered in patients with altered levels of consciousness.