Metronidazole-Induced Central Nervous System Toxicity

作者：Akira Kuriyama, Jeffrey L. Jackson, Asako Doi, Toru Kamiya · 发表于：Clinical Neuropharmacology · 年份：2011 · DOI：10.1097/wnf.0b013e3182334b35 · 被引用次数：205 · 研究领域：Infectious Encephalopathies and Encephalitis、SARS-CoV-2 detection and testing、Bacterial Infections and Vaccines

OBJECTIVE: To assess patient and medication factors that contribute to metronidazole toxicity. DATA SOURCES: We searched PUBMED from 1965 through April 7, 2011, and performed a hand search of bibliographies. STUDY SELECTION: Case reports or case series reporting metronidazole-induced central nervous toxicity. DATA EXTRACTION: Two authors independently abstracted demographics, metronidazole indication, dose and duration, neurological manifestations, and outcomes as well as brain imaging findings. DATA SYNTHESIS: Among 64 patients, 48 (77%) had cerebellar dysfunction, 21 (33%) had altered mental status, and 8 (15%) had seizures. Patients' ages averaged 53.3 years (range, 12-87 years), and 64% were male. The median duration of metronidazole was 54 days, although 26% had taken it less than a week and 11% had taken it less than 72 hours. Among cases with outcome data, most patients either improved (n = 18 [29%]) or had complete resolution of their symptoms with discontinuation of metronidazole (n = 41 [65%]). There was no difference in resolution of symptom by age (P = 0.71) or sex (P = 0.34). The patients with cerebellar dysfunction were less likely to experience complete resolution than those with mental status changes or seizures (relative risk, 0.67; 95% confidence interval (CI), 0.49-0.92). Nearly all patients (n = 55 [86%]) underwent imaging of the brain: 44 (69%) underwent magnetic resonance imaging (MRI) and 12 (19%) underwent computed tomographic studies. All patients wit...