Levofloxacin-induced acute psychosis

Indian J Psychiatry. 2008 Jan-Mar; 50(1): 57–58. doi:  10.4103/0019-5545.39762

PMCID: PMC2745871

Copyright © Indian Journal of Psychiatry

Levofloxacin-induced acute psychosis

Nagaraja Moorthy,N. Raghavendra,and  P. N. Venkatarathnamma

Department of General Medicine, Sri Devaraj Urs Medical College and RLJ Hospital and Research Centre, Tamaka, Kolar, Karnataka, India

Correspondence: Dr. Nagaraja Moorthy, Department of General Medicine, Sri Devaraj Urs Medical College and RLJ Hospital and Research Centre, Tamaka, Kolar – 563 101, Karnataka, India. E-mail: drnagaraj_moorthy@yahoo.com

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

 This article has been cited by other articles in PMC.

Abstract

A wide range of drugs can cause mental status changes. Fluoroquinolones are one among them and are underrecognised.The CNS side effects of levofloxacin like headache, dizziness, restlessness, tremor, insomnia, hallucinations, convulsions, anxiety and depression are well documented. We report a rare case of middle aged diabetic male admitted to hospital with multiple infections who developed acute psychosis following levofloxacin administration.

Keywords: Acute psychosis, fluoroquinolones, levofloxacin

INTRODUCTION

Fluoroquinolones are an under-recognized cause of changes in mental status. Delirium and hallucinations associated with fluoroquinolones have been reported, particularly with ciprofloxacin.[1] The proposed mechanism involved in the development of such side effects seems to be related to the quinolones’ ability to inhibit the binding of y-aminobutyric acid (GABA) to the GABA receptors, leading to central nervous system (CNS) excitation.[2] We report here a rare case of levofloxacin-induced acute psychosis encountered during treatment of a diabetic adult with multiple infections.

• Other Sections▼
  • Abstract
  • INTRODUCTION
  • CASE HISTORY
  • DISCUSSION
  • CONCLUSION
  • REFERENCES

CASE HISTORY

A 50-year-old man, nonalcoholic, with uncontrolled diabetes mellitus and hypertension was admitted to the hospital with history of high-grade fever and cough with scanty expectoration, of 2 days’ duration; and burning micturition and ulcer over left foot. Clinically the patient was febrile and diagnosed to have community-acquired left lower lobe pneumonia with urinary tract infection and cellulites of left foot.

Organic psychosis induced by ofloxacin and metronidazole.

Br J Hosp Med (Lond). 2009 Apr;70(4):236-7.

Koul S, Bhan-Kotwal S, Jenkins HS, Carmaciu CD.

Source

Birmingham and Solibull Mental Health Foundation Trust, Birmingham.

PMID:

19357607

[PubMed - indexed for MEDLINE]

Organic psychosis induced by ofloxacin and metronidazole

Unknown or invalid date

CASE REPORT Organic psychosis induced by ofloxacin and metronidazole Introduction Antimicrobial agents are a recognized cause of psychopathological and neurological adverse drug reactions (Table 1) (Farrington et al, 1995). However, relatively few of these patients are seen by psychiatrists. This article presents an unusual case in a young woman. Discussion A catatonic, depressive or organic stupor was initially considered in the differential diagnosis. Subsequently, a schizophreniform psychotic picture emerged and then a gradual and spontaneous reduction of all symptoms without psychotropic medication. The patient described many symp-toms at different times during this episode, e.g. paranoid delusions, delusions of reference and control, third person auditory hallucinations, suicidal ideation, tearfulness, psychomotor retardation and psychomotor agitation. There was no identifiable stressor that could have triggered a disassociative stupor Case Report An 18-year-old black African woman was referred to the on-call medical team by her GP with a history of confusion and

stupor. Three weeks before admission she complained of abdominal pain and was treated for urinary tract infection with co-amoxiclav. After 1 week, as her pain persisted, co-amoxiclav was stopped and she was treated for presumed pelvic inflammatory disease with ofloxacin 400 mg twice daily and metronidazole 400 mg three times daily. After 2 days on this combination she started to develop confusion, so her mother stopped the ofloxacin. The next day her GP advised her to also stop the metronidazole. During the next 5 days she became increasingly confused, frightened, almost mute and at times immobile. She was referred urgently to the accident and emergency department from where she was admitted to the medical ward.

Clarithromycin-induced hypomania in a child – a case report

Keywords:

• child;
• clarithromycin;
• adverse effects;
• hypomania

Baranowski WJ. Clarithromycin-induced hypomania in a child – a case report.

Objective:  We report here a child developing hypomania while treated with clarithromycin.

Method:  Case report.

Results:  A 3-year-old boy was treated for pneumonia with oral clarithromycin in monotherapy. The boy became somewhat hyperactive and irritable after the second dose. After the third dose he presented with psychomotor agitation, pressured speech, irritability, aggressive behaviour and insomnia. The antibiotic was identified as the only possible cause of the described clinical picture and was discontinued immediately. The hypomanic symptoms subsided gradually over 36 h.

Conclusion:  Commonly-used medications can produce uncommon adverse reactions. Clinicians, especially general practitioners, pediatricians, as well as child and adolescent psychiatrists ought to be aware of such a possibility when evaluating a child with suddenly changed behaviour.

Clarithromycin, a macrolide antibiotic similar to erythromycin, is frequently used to treat a variety of bacterial infectious diseases. The drug is associated with various adverse effects, including several psychiatric symptoms. Clarithromycin-induced hypomania or mania in adults has been reported several times, but no such reactions have previously been reported in children.

Clarithromycin-induced mania in a child.

Int J Clin Pharmacol Ther. 2009 Jun;47(6):402-4.

Fidan T, Fidan V.

Source

Ataturk University, Faculty of Medicine Child Psychiatry, Erzurum, Turkey. tulincps@hotmail.com

Abstract

Clarithromycin is a macrolide antibiotic widely used in children with respiratory infections. Mania is an extremely rare psychiatric side effect. A pediatric case of typical manic symptoms associated with clarithromycin-use and resembling those in adults is presented. It was notable that the patient had no genetic predisposition.

PMID:

19473602

[PubMed - indexed for MEDLINE]

Antimicrobial-induced mania (antibiomania): a review of spontaneous reports.

J Clin Psychopharmacol. 2002 Feb;22(1):71-81.

Abouesh A, Stone C, Hobbs WR.

Source

Southern Virginia Mental Health Institute, Danville, VA 24541, USA.

Abstract

The authors reviewed reported cases of antibiotic-induced manic episodes by means of a MEDLINE and PsychLit search for reports of antibiotic-induced mania. Unpublished reports were requested from the World Health Organization (WHO) and the Food and Drug Administration (FDA). Twenty-one reports of antimicrobial-induced mania were found in the literature. There were 6 cases implicating clarithromycin, 13 implicating isoniazid, and 1 case each implicating erythromycin and amoxicillin. The WHO reported 82 cases. Of these, clarithromycin was implicated in 23 (27.6%) cases, ciprofloxacin in 12 (14.4%) cases, and ofloxacin in 10 (12%) cases. Cotrimoxazole, metronidazole, and erythromycin were involved in 15 reported manic episodes. Cases reported by the FDA showed clarithromycin and ciprofloxacin to be the most frequently associated with the development of mania. Statistical analysis of the data would not have demonstrated a significant statistical correlative risk and was therefore not undertaken. Patients have an increased risk of developing mania while being treated with antimicrobials. Although this is not a statistically significant risk, physicians must be aware of the effect and reversibility. Further research clearly is required to determine the incidence of antimicrobial-induced mania, the relative risk factors of developing an antimicrobial-induced manic episode among various demographic populations, and the incidence of patients who continue to have persistent affective disorders once the initial episode, which occurs while the patient is taking antibiotics, subsides. The authors elected to name this syndrome “antibiomania.”

PMID:

11799346

[PubMed - indexed for MEDLINE]

Ciprofloxacin-induced manic episode.

Psychosomatics. 2006 Nov-Dec;47(6):539-40.

Ciprofloxacin-induced manic episode.

Bhalerao S, Talsky A, Hansen K, Kingstone E, Schroeder B, Karim Z, Fung I.

Comment in

• Psychosomatics. 2007 Jul-Aug;48(4):363.

PMID:

17116962

[PubMed - indexed for MEDLINE]

Ciprofloxacin-Induced Manic Episode

Shree Bhalerao, P.G.D., M.D., FRCPC, Univ. of Toronto School of Medicine, Aaron Talsky, B.Sc., Keith Hansen, N.P., Edward Kingstone, M.D., Ben Schroeder, B.Sc., Zamil Karim, B.Sc., and Irene Fung, B.Sc., Toronto, ON Canada

TO THE EDITOR: Ciprofloxacin is among the most frequentlyprescribed antimicrobials; however, its neuropsychiatric effectsare not thoroughly known. Although there have been previousisolated mentions in the literature of fluoroquinolones,¹ andciprofloxacin, specifically, precipitating central nervous systemdisturbances,^1–3 We believe that this is the first reportof ciprofloxacin-induced mania.

Case Report

“Mr. M” is a 28-year-old white man with a history of primarysclerosing cholangitis and controlled ulcerative colitis treatedwith sulfasalazine. He was admitted to the hospital after onsetof painless jaundice, pruritis, fatigue, and anorexia. Endoscopicretrograde cholangiopancreatogram (ERCP) demonstrated distalcommon bile-duct stricture, and initial stenting was unsuccessful.Thereafter, he developed clinical signs of suppurative cholangitis.Four days later, a second ERCP stenting proceeded successfully.

Postoperative treatment was metronidazole 500 mg IV bid, cefazolin1 g IV q8h, ciprofloxacin 400 mg IV bid, gravol 25 mg–50mg q4h, ursodeoxycholic acid 1,500 mg po bid, and folate 1 mgpo od. On Postoperative Day 1, sulfasalazine 300 mg po tid wasadded and increased the next day to his pre-admission dose of1,000 mg po tid. The patient quickly improved clinically, andwas discharged with stable vital signs on Postoperative Day5. All medications were discontinued except ciprofloxacin, tobe continued at 500 mg po bid.

Neurotoxicity and aggressiveness triggered by low-level lead in children: a review

Kelly Polido Kaneshiro Olympio,1 Claudia Gonçalves,2
Wanda Maria Risso Günther,1 and Etelvino José Henriques Bechara 3

Lead-induced neurotoxicity acquired by low-level long-term exposure has special relevance for
children. A plethora of recent reports has demonstrated a direct link between low-level lead exposure
and deficits in the neurobehavioral-cognitive performance manifested from childhood
through adolescence. In many studies, aggressiveness and delinquency have also been suggested
as symptoms of lead poisoning. Several environmental, occupational and domestic
sources of contaminant lead and consequent health risks are largely identified and understood,
but the occurrences of lead poisoning remain numerous. There is an urgent need for public
health policies to prevent lead poisoning so as to reduce individual and societal damages and
losses. In this paper we describe unsuspected sources of contaminant lead, discuss the economic
losses and urban violence possibly associated with lead contamination and review the
molecular basis of lead-induced neurotoxicity, emphasizing its effects on the social behavior,
delinquency and IQ of children and adolescents.
Lead poisoning; neurotoxicity syndromes; oxidative stress; juvenile delinquency

http://revista.paho.org/uploads/1254492093.pdf

 

Psychosis or simply a new manifestation of neurosyphilis?

J Int Med Res. 2006 May-Jun;34(3):335-7.

Kararizou E, Mitsonis C, Dimopoulos N, Gkiatas K, Markou I, Kalfakis N.

Source

Department of Neurology, Eginition Hospital, Athens National University, Athens, Greece. ekarariz@med.uoa.gr

Abstract

The widespread use of antibiotics in recent years has caused a significant reduction in the incidence of neurosyphilis and changes in its clinical features. We present a case that initially presented as persistent headache and untreatable psychosis. Neurosyphilis was diagnosed during the clinical evaluation. Blood serum analyses for syphilis were positive for rapid plasma reagin titres, the Venereal Disease Research Laboratories test and fluorescent treponemal antibody absorption. A lumbar puncture was performed and cerebrospinal fluid analysis resulted in the diagnosis of neurosyphilis. The patient completed a 2-week course of treatment with aqueous crystalline penicillin G and his symptoms subsequently improved. We suggest that neurosyphilis should always be included in the differential diagnosis of untreatable psychosis.

PMID:

16866029

[PubMed - indexed for MEDLINE]

How to try this: Delirium superimposed on dementia.

Am J Nurs. 2008 Jan;108(1):52-60; quiz 61.

Fick DM, Mion LC.

Source

School of Nursing, Pennsylvania State University, University Park, PA, USA.

Erratum in

• Am J Nurs. 2008 Feb;108(2):15.

Abstract

Delirium is common in older adults who have dementia, but too often nurses confuse the symptoms of delirium with those of dementia and it goes unrecognized and untreated. Delirium can signal a serious underlying condition such as infection or dehydration and can increase the risk of falling and the length of hospitalization. This article presents an algorithm meant to guide nurses in the assessment and treatment of delirium superimposed on dementia. For a free online video demonstrating the use of this algorithm, go to http://links.lww.com/A211 [corrected].

[Delirium induced by drug treatment].

Ther Umsch. 2011 Jan;68(1):27-33.

[Article in German]

Back C, Wittmann M, Haen E.

Source

Klinische Pharmakologie, Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie der Universität Regensburg.

Abstract

Delirium may be induced by a variety of reasons, among them drugs and in particular the combination of drugs. In elderly people a delirium is often misinterpreted as dementia. Anticholinergic activity is the mode of action by which drugs cause delirium. Antipsychotic drugs, antidepressants, antihistamines, and of course anticholinergic drugs themselves are the major anticholinergic classes of drugs. In addition some opioids have anticholinergic effects. Other drugs may induce delirium by dehydration (loop diuretics like furosemide) or sedation (benzodiazapines like lorazepam). Elderly people are at especially high risk to develop delirium, because of the multitude of drugs often prescribed to them, because they tend to drink to little, and because their brain is more sensitive to psychoactive drugs.

PMID:

21184391

[PubMed - indexed for MEDLINE