Neurotoxic effects of antimicrobial agents

Antimicrobial agents are occasionally responsible for significant neurological toxicity, the incidence of which is difficult to determine due to numerous confounding factors. It is nonetheless crucial to include this possibility in the differential diagnosis of any new or worsening neurological condition happening during antimicrobial treatment. Except for well described side effects (aminoglycoside ototoxicity) it is a rule out diagnosis and often necessitates a thorough metabolic and neurological work up. Once the diagnosis is strongly suspected, the therapeutic approach should always include the discontinuation of the offending agent, supportive measures and occasionally specific treatment. This article describes the wide possible neurological presentations and includes summary tables according to antimicrobial class.