【Abstract】 Objective Ceftazidime-induced neurotoxicity is often underestimated or misinterpreted by clinicians. To understand this ailment, we described 21 hemodialysis cases with ceftazidime-related neurotoxicity, and compared the effect of ceftazidime clearance by different blood purification methods. Methods We recruited the maintenance hemodialysis (MHD) patients complicated with psychiatric symptoms after ceftazidime treatment in Guangdong General Hospital from 1999 to 2008. Their neurotoxic symptoms induced by ceftazidime, and blood ceftazidime concentrations before and after hemodialysis were observed. Their clinical symptoms were then analyzed along with the efficiency of ceftazidime clearance by different blood purification methods. Results The involvement of central nervous system induced by ceftazidime treatment was found in 21 chronic renal failure patients on MHD. Their average age was 69.1±6.4 years old, indicating the higher incidence in older patients. The frequent findings included confusion and spatial disorientation (81% patients), myoclonus (62%), and psychiatric disturbances (52%). The average Glassgow score increased, and recovery from neurotoxicity began after blood purification in all these patients. Neurotoxocity improved in less than 24 hours after blood purification. Blood ceftazidim concentrations before and after blood purification were measured in 13 cases, of which 5 cases were treated with hemodialysis, and 8 cases with on-line hemodiafiltration. The ceftazidime clearance was more efficient by hemodiafiltration than by hemodialysis, in accordance with the differences of symptom improvement by the two blood purification methods. Conclusions Ceftazidime can induce neurotoxicity in MHD patients. For elderly MHD patients, ceftazidime dose should be adjusted to avoid neurotoxicity. Awareness of the potential nervous system complications following ceftazidime administration should be emphasized.