How epileptogenic are the recent antibiotics?

OBJECTIVE: To review the clinical and experimental data concerning the serious neurologic adverse events, and more particularly seizures, which could be related to the administration of recent antibiotics, with special reference to cephalosporins, monobactams, carbapenems, and fluoroquinolones. DATA SOURCES: We have searched in the MEDLINE database over the years 1966-1998 the pertinent publications dealing with antibiotics related neurotoxicity. We used the thesaurus function and the following key words: antibiotics, neurotoxicity, seizures. Additional references were found in the articles sorted by the MEDLINE search. DATA SYNTHESIS: Neurotoxic manifestations following antibiotics administration are infrequently encountered under usual conditions. Experimental studies are helpful to demonstrate that these compounds might interact with a major component of the neurotransmission, the gamma aminobutyric acid (GABA) receptor complex. Structure-toxicity relationships can be described. For the clinician, the recognition of some predisposing factors related either to the patient (age, previous central nervous system disorder ...) or to the drug metabolism (reduced renal clearance, drug interactions ...) may help to minimise the risk of adverse neurologic manifestations. Several factors have to be taken into account before assessing causality: delay from administration, evolution, origin of the adverse event (risk factors, other drugs, non pharmacological origin), possibility of rechallenge, confirmation by biological testing or in vitro experiments...