Drugs with a negative impact on cognitive functions (part 3): antibacterial agents in patients with chronic kidney disease
Authors: Liabeuf Sophie , Hafez Gaye , Pešić Vesna , Spasovski Goce , Bobot Mickaël , Mačiulaitis Romaldas , Bumblyte Inga Arune , Ferreira Ana Carina , Farinha Ana , Malyszko Jolanta , Pépin Marion , Massy Ziad A , Unwin Robert , Capasso Giovambattista , Mani Laila-Yasmin ,   CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target), Capasso Giovambattista , Andrade Alexandre , Arici Mustafa , Bachmann Maie , Bailey Matthew , Barbieri Michelangela , Bobot Mickaël , Bruchfeld Annette , Bumblyte Inga , Calcutta Antonello , Capolongo Giovanna , Carriazo Sol , Ceccarelli Michele , Covic Adrian Constantin , De Ananya , Delgado Pilar , Endlich Nicole , Endres Matthias , Esposito Fabrizio , Farisco Michele , Faucher Quentin , Ferreira Ana Carina , Figurek Andreja , Fouque Denis , Franssen Casper , Fridolin Ivo , Frische Sebastian , Garneata Liliana , Gesualdo Loreto , Giannakou Konstantinos , Godefroy Olivier , Golenia Aleksandra , Goumenos Dimitrios , Gryguc Agnė , Jiménez Eugenio Gutiérrez , Hafez Gaye , Hoorn Ewout , Silva Pedro Henrique Imenez , Izhar Raafiah , Kelly Dearbhla , Kesler Shelli , Klimkowicz-Mrowiec Aleksandra , Knauss Samuel , Kurganaite Justina , Levassort Hélène , Liabeuf Sophie , Malyszko Jolanta , Mani Laila-Yasmin , Martino Gianvito , Massy Ziad , Mayer Christopher , Mucci Armida , Mutevelic-Turkovic Alma , Nielsen Rikke , Nitsch Dorothea , Ortiz Alberto , Panagiotopoulos Vasileios , Paolisso Giuseppe , Pejušković Bojana , Pepin Marion , Perna Alessandra , Perrottelli Andrea , Pešić Vesna , Pezzella Pasquale , Rroji (Molla) Merita , Rychlík Ivan , Sakkas Giorgos , Simeoni Mariadelina , Romeo Maria José Soler , Spasovski Goce , Starčević Ana , Tedeschi Gioacchino , Trevisani Francesco , Unwin Robert , Vazelov Evgueniy , Wagner Carsten Alexander , Wagner Franca , Wanner Christoph , Wiecek Andrzej , Xu Hong , Zacchia Miriam , Zacharia Lefteris , Zecchino Irene , Zoccali Carmine , Raso Francesco Mattace , Endlich Karl Hans , Perico Norberto , Remuzzi Giuseppe , Trepiccione Francesco , Okusa Mark , Di Marzo Vincenzo , Blankestijn Peter , Eckardt Kai-Uwe , Konig Maximilian 
Published: June 2024

The relationship between chronic kidney disease (CKD) and cognitive function has received increased attention in recent years. Antibacterial agents (ABs) represent a critical component of therapy regimens in patients with CKD due to increased susceptibility to infections. Following our reviewing work on the neurocognitive impact of long-term medications in patients with CKD, we propose to focus on AB-induced direct and indirect consequences on cognitive function. Patients with CKD are predisposed to adverse drug reactions (ADRs) due to altered drug pharmacokinetics, glomerular filtration decline, and the potential disruption of the blood–brain barrier. ABs have been identified as a major cause of ADRs in vulnerable patient populations. This review examines the direct neurotoxic effects of AB classes (e.g. beta-lactams, fluoroquinolones, aminoglycosides, and metronidazole) on the central nervous system (CNS) in patients with CKD. We will mainly focus on the acute effects on the CNS associated with AB since they are the most extensively studied effects in CKD patients. Moreover, the review describes the modulation of the gut microbiota by ABs, potentially influencing CNS symptoms. The intricate brain–gut–kidney axis emerges as a pivotal focus, revealing the interplay between microbiota alterations induced by ABs and CNS manifestations in patients with CKD. The prevalence of antibiotic-associated encephalopathy in patients with CKD undergoing intravenous AB therapy supports the use of therapeutic drug monitoring for ABs to reduce the number and seriousness of ADRs in this patient population. In conclusion, elucidating AB-induced cognitive effects in patients with CKD demands a comprehensive understanding and tailored therapeutic strategies that account for altered pharmacokinetics and the brain–gut–kidney axis.