Cefepime 臨床上廣泛用於治療革蘭氏陰性及陽性菌之感染。此抗生素引起之神經學副作用主要有意識不清、癲癇及非抽搐性重積性癲癇等表現，特別容易發生於腎功能不全患者。引起此不良反應之危險因子為老年人、腎功能不全（包含血液透析）、急重症患者及使用超過建議劑量，由於產生神經學副作用的時間大約在用藥後2 ~ 4天，並且有較差預後及較高死亡率，若臨床上懷疑cefepime 導致的神經學副作用，能及早判斷並立即停藥，並依嚴重程度給予適當處置，如抗癲癇藥物治療，或血液透析以降低cefepime 血液濃度，可避免病患產生較差預後或死亡。此篇我們報導兩位長期血液透析老年病患因使用較高cefepime 劑量（未調整劑量）引起中樞神經相關副作用之案例，副作用發生皆在非洗腎日，其中1 名雖降低劑量仍因較晚停藥而產生非抽搐性重積性癲癇，並需長期使用抗癲癇藥物。藥師應留意有相關危險因子的患者，建議cefepime 合適劑量與監測相關神經學表現，或改用其他抗生素，並且適時給予藥物不良反應評估及介入。

Cefepime is widely used in the treatment of infections caused by gram-positive and gram-negative bacteria. Neurotoxic symptoms include disturbed consciousness, seizure, and non-convulsive status epilepticus that are more prevalent in patients with renal impairment. The risk factors are old age, renal impairment or ongoing hemodialysis, critical illness, and cefepime overdose. The onset time of these adverse effects is short, ranging from 2 to 4 days, and leads to high morbidity and mortality. Physicians should be aware of the signs and symptoms to discontinue cefepime immediately and commence antiepileptic drug therapy or hemodialysis in severe cases. We report two cases of cefepime-induced neurotoxicity exhibited by disturbed consciousness and status epilepticus. The events occurred on a non-dialysis date. The patients were elderly, underwent regular hemodialysis, and received a higher unadjusted dose of cefepime. One of the cases developed non-convulsive status epilepticus owing to delayed cefepime discontinuation and required long-term treatment with antiepileptic drugs. These cases emphasize that pharmacists should pay attention to patients with related risk factors and respond to drug-related problems such as renal dose adjustments, and monitoring neurotoxicity, alternative antibiotics, and adverse drug reactions.