Antibiomania: A Rare Case of Metronidazole-Induced Mania

Puri, P; Parnami, Pankul; Chitkara, Akshit; Athwal, Pal Satyajit Singh; Khetrapal, Sunil

doi:10.7759/cureus.12414

Cited by 7 publications

(9 citation statements)

References 11 publications

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“…Metronidazole's most common side effects are diarrhea, abdominal pain, and nausea [ 3 ]. It has been reported in the literature that metronidazole can cause liver injury [ 4 ], neurotoxicity [ 5 ], pancreatitis [ 6 ], and possible mania [ 7 ]. It can also cause disulfiram-like reactions similar to other drugs like sulfonamides, nitrofurantoin, and chloramphenicol as they’re believed to interfere with alcohol metabolism causing these reactions that can be severe enough to cause mortality.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Metronidazole Overdose Causing Ventricular Fibrillation

Elgassim¹,

Saied²,

Mustafa³

et al. 2022

Cureus

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Ventricular fibrillation is not known as a complication of metronidazole poisoning. Although some arrhythmias have been reported as a complication of metronidazole intake while taking antiarrhythmic medications, most such arrhythmias are possibly related to co-ingestion of drugs with metronidazole as it affects the metabolism of these drugs. In this case, ventricular fibrillation occurred in a young patient without preexisting medical conditions or any other known drug ingestion, which was never been reported before. We present a case of an 18-year-old male brought in by the ambulance service after attempting to end his life by overdosing on metronidazole. While being transported he developed ventricular fibrillation and received an electric shock, which reverted the episode. Laboratory investigations did not show any clear cause that might have precipitated his arrhythmia.

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Section: Discussionmentioning

confidence: 99%

A Rare Case of Metronidazole Overdose Causing Ventricular Fibrillation

Elgassim¹,

Saied²,

Mustafa³

et al. 2022

Cureus

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“…In addition, gamma aminobutyric acid (GABA) is decreased from the use of these antibiotics. A systematic review shared hypothesis of quinolones competing for and inhibiting GABA receptor sites and clarithromycin antagonizing postsynaptic GABA-A receptors in neuron while isoniazid showed glutamic acid decarboxylase (GAD) enzyme inhibition [15][16][17][18]. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has listed antibiotic use as a causative factor for secondary mania [17].…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review shared hypothesis of quinolones competing for and inhibiting GABA receptor sites and clarithromycin antagonizing postsynaptic GABA-A receptors in neuron while isoniazid showed glutamic acid decarboxylase (GAD) enzyme inhibition [15][16][17][18]. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has listed antibiotic use as a causative factor for secondary mania [17]. Antibiotics are very commonly known to exert a modifying effect on the immune system in addition to exerting antimicrobial effect.…”

Section: Discussionmentioning

confidence: 99%

Exacerbation of Mania due to Metronidazole in a Bipolar Disorder Patient

AlShakori

Arain

Thorakkattil

et al. 2022

Case Reports in Psychiatry

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Bipolar disorder is a mental health disorder where the patient experiences extreme shifts in mood marked by depression, mania, or hypomania. It affects their overall daily life activities and sleep patterns. This case report is of a 74-year-old female patient with bipolar disorder who experienced a manic episode after initiation of antibiotics to treat gallbladder perforation with abscess formation. The patient’s past medical history included Parkinson’s disease, diabetes mellitus, bipolar disorder, and acalculous cholecystitis. The patient required hospitalization for a cholecystostomy tube insertion for drainage. During hospitalization, the patient was started on empiric treatment with broad-spectrum antibiotics, including piperacillin/tazobactam and metronidazole. The patient remained stable during the inpatient stay and was discharged home one week later. She was prescribed cefuroxime and metronidazole to complete a 2-week duration of antibiotics. However, upon discharge, she developed manic symptoms, including lack of need to sleep, excessive talking, and severe agitation. Upon assessment, the psychiatric team decided to hold metronidazole as it has an adverse effect of mania as evidenced in drug information resources. The patient started to show immediate recovery from the symptoms with complete resolution of manic symptoms on the 3rd day following the discontinuation of metronidazole. This case emphasizes the increased need for vigilance in bipolar patients upon prescribing metronidazole. Also, further research is needed to predict the time to onset of manic symptoms and improvement in patient symptoms upon drug discontinuation.

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“…This infers that the withdrawal of the drug does not undo the harm caused. With some antibiotics, however, adverse effects are caused in a dose-dependent fashion, in such cases, dosage adjustments are necessitated [2,[38][39][40][41][42][43][44][45][46][47][48][49][50][51]. It may not be practical to completely withdraw the causative agent at all times though [39].…”

Section: Evaluation and Managementmentioning

confidence: 99%

Neuropsychiatric Adverse Effects of Antibacterial Agents

Cyriac

Iype

2021

Int J Pharm Pharm Sci

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Anti-bacterial are agents that inhibit bacterial growth or kills bacteria and are a sub-type of antimicrobials. These are drugs used to treat infections, but they sometimes pose a threat of adverse events. Some of these adverse events are neuropsychiatric, which are generally hard to diagnose and is often paid less attention. They account for about 30% of total Adverse drug reactions (ADRs) caused by drugs in patients without mental abnormalities. The spectrum ranges from episodes of seizure to acute psychosis. The article emphasizes the frequency of such adverse events and means to raise awareness among medical practitioners regarding the same. The various neuropsychiatric adverse effects and the agents responsible have been reviewed, along with their possible mechanisms and general management. The information for writing this review was selected by searching for keywords such as Neurotoxicity, GABA, Psychosis, Naranjo scale, and Antibiomania in databases such as Google Scholar, PubMed, Elsevier, etc. After searching the articles in the above-mentioned databases, the articles were screened concerning their importance with our work and according to their title and abstract. Additional articles were discovered by checking the references in the current study's citations. Using this method, the various neuropsychiatric adverse effects of Antibacterial agents were summarized in this review.

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Antibiomania: A Rare Case of Metronidazole-Induced Mania

Cited by 7 publications

References 11 publications

A Rare Case of Metronidazole Overdose Causing Ventricular Fibrillation

A Rare Case of Metronidazole Overdose Causing Ventricular Fibrillation

Exacerbation of Mania due to Metronidazole in a Bipolar Disorder Patient

Neuropsychiatric Adverse Effects of Antibacterial Agents

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