Antimicrobial-Induced Mania (Antibiomania): A Review of Spontaneous Reports

Abouesh, Ahmed; Stone, Chip; Hobbs, William R.

doi:10.1097/00004714-200202000-00012

Cited by 135 publications

(78 citation statements)

References 22 publications

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“…5 The WHO reported 82 cases of anti-biomania (antimicrobial induced mania). 6 Of these, clarithromycin was implicated in 23 (27.6%) cases, ciprofloxacin in 12 (14.4%) cases, and ofloxacin in 10 (12%) cases. Rest cases stemmed from cotrimoxazole, metronidazole, and erythromycin.…”

Section: Discussionmentioning

confidence: 99%

Levofloxacin induced psychosis: a rare case report

Singh

Kapoor

Singhal

et al. 2014

Int J Basic Clin Pharmacol

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Section: Discussionmentioning

confidence: 99%

Levofloxacin induced psychosis: a rare case report

Singh

Kapoor

Singhal

et al. 2014

Int J Basic Clin Pharmacol

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“…hearing, seeing, feeling) of something that does not actually exist. This may involve hearing voices or seeing patterns, light, objects, and things that do not exist [7,9]. A lot of conditions can commonly cause hallucinations, which in some cases are common symptoms of diseases (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…

Case reportA 64-year-old electronic engineer, with a history of hypertension kept under control with irbesartan 300 mg/die and atenolol 100 mg/die, came to our observation 48 h after the onset of tremors and hallucinations.Six days before hospital admission the patient started amoxacillin-clavulanate 1 gr/tid for fever (37.5-38.5°C) and general discomfort, but this therapy was interrupted 3 days after for the onset of urticaria, and replaced with erythromycin (1 gr/bids) and methylprednisolone (16 mg/ bids), no antihistamines were used. Twenty-four hours after the beginning of this new therapy, the patient complained of visual and auditory hallucinations which he lived with particular anguish.

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Hallucinations and tremors due to oral therapeutic doses of erythromycin and methylprednisolone

Gallerani

Boari

2008

Intern Emerg Med

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Various medications, including antibiotics and steroids, can cause neurological adverse reactions, among which tremors [1,2], extrapyramidal syndrome [3], and delirium [4][5][6][7][8].We present a case of hallucinations and tremors started after therapeutic use of erythromycin and steroids. Case reportA 64-year-old electronic engineer, with a history of hypertension kept under control with irbesartan 300 mg/die and atenolol 100 mg/die, came to our observation 48 h after the onset of tremors and hallucinations.Six days before hospital admission the patient started amoxacillin-clavulanate 1 gr/tid for fever (37.5-38.5°C) and general discomfort, but this therapy was interrupted 3 days after for the onset of urticaria, and replaced with erythromycin (1 gr/bids) and methylprednisolone (16 mg/ bids), no antihistamines were used. Twenty-four hours after the beginning of this new therapy, the patient complained of visual and auditory hallucinations which he lived with particular anguish. Later, he also presented tremors that progressively compromised his common daily activities, i.e. eating, dressing, writing, walking and standing up.On admission, body temperature, heart rate and blood pressure were 36.7°C, 66/bpm rythmic and 105/70 mmHg, respectively. No signs of previous urticaria were present. Cardiovascular and respiratory examinations were normal.The liver was palpable at 2 cm below the right costal margin, without tenderness. There were neither clubbing nor superficial lymphadenopathies. Carotid pulses were symmetrically normal. The patient exhibited tremors of head and face, especially of mouth and tongue, and a postural tremor of upper and lower limbs, which increased during movement and altered stability during standing and walking. Alteration of balance and gait was due to the effect of tremor, not to cerebellar disorder or postural instability.Also writing was particularly difficult and uncertain (Fig. 1). Tremors were absent during sleep. The remaining neurological examination was normal, and in particular deep tendon reflexes, tactile, temperature and vibration sensation were normal.All laboratory exams (including thyroid and liver functions, and all electrolytes: sodium, potassium, chlorine, calcium, magnesium and phosphate) were normal. Blood, stool, and urine cultures were negative as well as an antibodies' search for legionella, mycoplasma, chlamydia, toxoplasma and Epstein-Barr Virus.On the second day of hospitalization, an electroencephalogram showed a good organization of the activity, even if unstable due to drowsiness.Electrocardiogram, chest and cervical x-ray, abdominal ultrasound, echocolordoppler of carotid arteries and brain MRI scan were normal.In the hypothesis that the clinical situation could be due to the assumption of erythromycin and steroid therapy, we suspended these drugs immediately, and no other therapy was administrated.In the following days, the symptoms quickly improved with the disappearance of the hallucinations in about 48 h, and the progressive reduction of the tremors, with ...

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“…Regarding the number of antibiomania cases reported by the WHO and the FDA, clarithromycin seems to be the antibiotic most frequently implicated in the occurrence of this adverse effect, followed by ciprofloxacin and ofloxacin 2 .…”

Section: Introductionmentioning

confidence: 99%

Antibiomania after triple therapy for Helicobacter Pylori: Two case reports and a review of physiopathology

et al. 2014

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-Background and Objectives:The onset of manic symptoms in middle age requires clinicians to consider possible reversible causes, especially in patients with no previous psychiatric history. A number of drugs have been implicated as being among possible causes. The term antibiomania appeared to define cases of antibiotic-induced manic symptoms. This is a serious, but rare, adverse event. Several studies have described antimicrobial agents as being responsible for antibiomania. Our objective is to investigate the possible induction of manic symptoms by clarithromycin through two case reports and a review of the literature.Methods: We report two cases of clinical manic psychotic symptoms arising in the context of treatment with triple therapy for Helicobacter pylori eradication. In addition, we summarize, in an unsystematic way, previously published evidence and pathophysiological mechanisms proposed.Conclusions: These and other previously published cases suggest that the use of triple therapy, and especially of clarithromycin, should always be considered as a possible cause of acute manic or psychotic episode. Published evidence on the pathophysiological mechanisms is speculative so the identification and dissemination of a larger number of antibiomania cases and systematic study of them may help us to understand the underlying pathophysiological mechanisms and improve our diagnostic skills.

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Antimicrobial-Induced Mania (Antibiomania): A Review of Spontaneous Reports

Cited by 135 publications

References 22 publications

Levofloxacin induced psychosis: a rare case report

Levofloxacin induced psychosis: a rare case report

Hallucinations and tremors due to oral therapeutic doses of erythromycin and methylprednisolone

Antibiomania after triple therapy for Helicobacter Pylori: Two case reports and a review of physiopathology

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