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Mini Review Volume 14 Issue 1
Beta-lactam–induced neurotoxicity: a narrative review of clinical impact, pathophysiological mechanisms, and practical approach
Karen Marileo-Araus, Pola Fernández-Rocca, Elena Vega
Received: December 26, 2025 | Published: January 12, 2026
Citation: Marileo-Araus K, Fernández-Rocca P,Vega E. Beta-lactam–induced neurotoxicity: a narrative review of clinical impact, pathophysiological mechanisms, and practical approach. Pharm Pharmacol Int J. 2026;14(1):1-4. DOI: 10.15406/ppij.2026.14.00485
Abstract
[tiab]) to ensure comprehensive coverage.5 The strategy was organized into three main conceptual components, combined using the AND operator. Component 1 (Beta-lactam Drugs): (“Cephalosporins”[MeSH] OR “Carbapenems”[MeSH] OR “Piperacillin-Tazobactam Combination”[MeSH] OR “Antibiotics”[MeSH] OR “Cefepime”[tiab] OR “Piperacillin- Tazobactam”[tiab]) Component 2 (Neurotoxic Events): (“Delirium”[MeSH] OR “Encephalopathy”[MeSH] OR “Seizures”[MeSH] OR “Neurotoxicity Syndromes”[MeSH] OR “Neurotoxicity”[tiab] OR “Encephalopathy”[tiab] OR “Seizures”[tiab] OR “Myoclonus”[tiab]) Pharm Pharmacol Int J. 2026;14(1):1‒4. 1 ©2026 Marileo-Araus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Beta-lactam–induced neurotoxicity: a narrative review of clinical impact, pathophysiological mechanisms, and practical approach Volume 14 Issue 1 - 2026 Facultad de Farmacia, Universidad de Concepción, Chile Correspondence: Elena María Vega, Departamento de Farmacia, Facultad de Farmacia, Universidad de Concepción, Barrio Universitario S/N, Concepción, Chile, T el +56-41-220 4208 Received: December 26, 2025 | Published: January 12, 2026 Abstract Background: Beta-lactam antibiotics are widely used and generally safe; however, they may cause neurotoxicity, particularly in hospitalized and critically ill patients. Early detection is crucial to reduce morbidity and mortality. Objective: To synthesize current evidence on the incidence, mechanisms, risk factors, clinical presentation, diagnostic approach, and management of beta-lactam–induced neurotoxicity (BLIN). Methods: A narrative literature review was conducted to identify relevant publications, employing a structured search strategy in the PubMed database. The search combined Medical Subject Headings (MeSH) and free-text terms to ensure comprehensive coverage, organized into three main conceptual components: beta-lactam drugs, neurotoxic events, and clinical context and risk. Information was extracted and synthesized qualitatively, with findings organized into a “problem–mechanism–solution” framework. Results: Ten eligible studies were identified. Cefepime was the beta-lactam most frequently associated with neurotoxicity. The predominant pathophysiological mechanism is concentration-dependent antagonism of the GABA-A receptor, although glutamatergic hyperactivity, oxidative stress, mitochondrial dysfunction, and blood–brain barrier disruption also contribute. Major risk factors include renal impairment, inappropriate dosing, advanced age, neurological comorbidities, sepsis, and critical illness. BLIN typically presents with acute encephalopathy, myoclonus, seizures, and non-convulsive status epilepticus. Diagnosis is clinical and exclusionary, supported by electroencephalography, therapeutic drug monitoring, and neuroimaging. Prompt drug discontinuation generally leads to improvement, while severe cases may require hemodialysis. Conclusions: Beta-lactam–induced neurotoxicity is a potentially severe yet reversible complication. Early recognition, individualized dosing, and close clinical monitoring are essential to reducing the risk of this preventable adverse effect.
Keywords: beta-lactam drugs, neurotoxicity, risk factors, therapeutic drug monitoring, management
©2026 Marileo-Araus, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.