Amoxicillin-Clavulanate–Induced Neurotoxicity in a Patient with End-Stage Renal Disease: A Case of Reversible Encephalopathy

Beta-lactam antibiotics are a known but underrecognized cause of neurotoxicity, particularly in patients with renal impairment. While cefepime-associated neurotoxicity is well described, less attention has been given to amoxicillin-clavulanate. We present a case of a 67-year-old male with end-stage renal disease (ESRD) on hemodialysis who developed acute encephalopathy characterized by agitation, confusion, and fluctuating consciousness shortly after initiation of 875/125 mg amoxicillin-clavulanate twice daily following hospital discharge. Symptoms began approximately 48 hours after antibiotic initiation and resolved upon discontinuation of the medication and initiation of hemodialysis. Extensive workup, including neuroimaging and electroencephalography, was unrevealing. Infectious and metabolic etiologies were excluded based on clinical evaluation and specialist consultation. The Naranjo Adverse Drug Reaction Probability Scale score was 3, indicating a possible adverse drug reaction. This case highlights the importance of recognizing antibiotic-induced neurotoxicity in patients with ESRD and emphasizes the risks of inappropriate outpatient dosing at hospital discharge.