Ceftazidime, cefepime, and ceftriaxone: delirium risk in older adults

Comparative Analysis of Delirium in Older Patients Treated With Selected Antibiotics: a Prospective Cohort Study

This project will see if three common cephalosporin antibiotics—ceftazidime, cefepime, and ceftriaxone—increase the chance of delirium in hospitalized people aged 65 and older being treated for infections.

Quick facts

• Study type: Observational
• Enrollment: 120 (estimated)
• Ages: 65 Years and up
• Sex: All
• Sponsor: Alexandria University (Academic / other)
• Locations: 1 site (Alexandria, Egypt)
• Trial ID: NCT07026253 on ClinicalTrials.gov

What this trial studies

This observational study will follow hospitalized patients aged 65 and older at Alexandria Main University Hospitals who receive ceftazidime, cefepime, or ceftriaxone for infections. Delirium will be screened with the Confusion Assessment Method (CAM) on days 2, 4, and 6 and severity measured with the Delirium Rating Scale (DRS-R98), while infection and organ status will be tracked with SOFA, QSOFA, and NEWS scores. Researchers will record renal and hepatic function and any antibiotic dose adjustments to examine their relationship with delirium onset, severity, and recovery time. Data will be compared across the three antibiotics to identify differences in delirium incidence and associated risk factors.

Who should consider this trial

Good fit: Hospitalized adults aged 65 or older at Alexandria Main University Hospitals who are being treated for infection with ceftriaxone, ceftazidime, or cefepime and who have no pre-existing delirium are the intended participants.

Not a fit: Patients in septic shock, those with known cephalosporin allergy, current use of medications that cause delirium, recent major surgery, severe electrolyte imbalances, active substance withdrawal, or people treated outside the study hospital are unlikely to benefit from this observational project.

Why it matters

Potential benefit: If successful, the findings could help clinicians choose and dose cephalosporin antibiotics to lower delirium risk and improve recovery in older hospitalized patients.

How similar studies have performed: Previous observational reports have linked certain cephalosporins—especially cefepime—to neurotoxicity and delirium, but direct head-to-head comparative data in older hospitalized patients are limited.

Eligibility criteria

Inclusion Criteria:

* Older adult patients aged 65 years or above.
* Hospitalized patients in Alexandria university hospitals diagnosed with infection and treated with selected cephalosporins (Ceftriaxone, Ceftazidime, or Cefepime).
* Patients without a history of Pre-existing delirium prior to hospitalization.

Exclusion Criteria:

* Patients with contraindications or allergies to cephalosporins.
* Patients with septic shock.
* Current use of medications known to cause delirium (anticholinergics, benzodiazepines, or opioid analgesics).
* Current or recent substance abuse (patients with a history of alcohol or drug abuse within the past year, or currently undergoing withdrawal). 5. Recent surgical procedures (patients who have undergone major surgery, particularly those requiring general anesthesia, within the last 30 days).
* Electrolyte imbalance (patients with severe electrolyte disturbances such as hypernatremia, hyponatremia, hypercalcemia or hypocalcemia at the time of study entry).
* Patients with End-stage renal disease requiring dialysis.
* Patients with severe liver disease (e.g., Child-C).
* Pain management issues: Patients with severe, uncontrolled pain that might independently affect cognitive function.

Where this trial is running

Alexandria, Egypt

• Alexandria Main University Hospitals — Alexandria, Egypt, Egypt (Recruiting)

Study contacts

• Study coordinator: Rana Kh Draz, Pharm D.

Conditions Delirium; cephalosporins; Antibiotics