Cerebral toxicity associated with massive intravenous penicillin therapy

Abstract

Two patients who were given massive doses of penicillin to combat bacterial infections were studied. Shortly after penicillin therapy was instituted, each of these patients developed muscular hyperirritability, myoclonic jerking movements, and generalized convulsions. One subject developed visual and auditory hallucinations; the other became semicomatose. Both subjects had evidence of impaired renal tubular function. Both demonstrated high serum penicillin levels hours after the penicillin was stopped, and in one patient remarkably high penicillin levels still persisted 36 hours after discontinuance. Both patients showed gradual recovery of normal cerebral function after the penicillin was stopped. The potential hazard of cerebral toxicity from high-dosage penicillin therapy, particularly in the presence of renal dysfunction, is emphasized.