Psychosis as an adverse effect of antibiotics

Abstract

Adverse neuropsychiatric effects of antibiotic medications have been well documented. There is evidence suggesting a direct relationship between acute psychosis and antibiotic exposure. Conversely, the tetracycline antibiotic minocycline has been associated with improvements in psychopathology in patients with psychotic disorders. The purpose of the present study was to investigate the prevalence of spontaneously reported adverse drug reactions (ADRs) of psychotic symptoms in adults for antibiotics and the odds of psychosis compared to minocycline for individual antibiotics and antibiotic classes. We searched the publicly available U.S. F.D.A. Adverse Event Reporting System (FAERS) from inception through March 2020 for which an antibiotic was the suspected agent of an adverse drug reaction (ADR). We investigated 23 different antibiotics, comprising 183,265 adverse event reports and 2955 psychosis ADRs. For individual antibiotics, the prevalence of psychosis ADRs ranged from 0.3 to 3.8%. Fifteen antibiotics were associated with a significantly increased odds of psychosis (OR ​= ​1.67–9.48), including penicillins, fluoroquinolones, macrolides, cephalosporins, and doxycycline. Our results suggest that psychosis is a potential adverse effect of antibiotic treatment, but risks vary by specific agents. Future studies in this area are needed to identify specific underlying biological mechanisms that contribute to these associations. Findings may also inform on clinical decisions regarding the selection of antibiotic therapy in vulnerable patient populations.

Neuropsychiatric Adverse Effects of Antibacterial Agents

“…However, in some cases, the underlying infectious condition itself (and not the antimicrobial) may be associated with exacerbation of psychosis. For example, the prevalence of comorbid infections during episodes of psychosis among schizophrenic patients, especially UTI are high [21]. A similar observation is the association between UTI and acute psychosis seen among geriatric patients [22].…”

“…These mechanisms are connected to the non-dopaminergic pathways for the development of psychosis [12,21,24]. In addition to these, the moderately lipophilic nature of Fluoroquinolones increases their ability to cross the blood-brain barrier [21]. The effect produced by Benzodiazepines and Barbiturates are effective treatment strategies in cases of Cephalosporin-induced epileptiform activity that supports the possibility of GABA blockade by Cephalosporins to cause neurotoxicity [10].…”

“…They also act directly on Alphaamino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors. These mechanisms are connected to the non-dopaminergic pathways for the development of psychosis [12,21,24]. In addition to these, the moderately lipophilic nature of Fluoroquinolones increases their ability to cross the blood-brain barrier [21].…”

COVID-19 Induced New-onset Psychosis: A Case Report from Oman

“… 15 The iatrogenic effects of the antibiotics ceftriaxone and azithromycin administered to this patient may also have had a role, as the occurrence of psychosis associated with antibiotics is known to vary between 0.3–3.8%. 16 A similar view has emerged regarding the two key COVID-19 medications, hydroxychloroquine 17 and dexamethasone, 18 which were administered to the patient in tandem or rapid succession.…”

Additional Studies on the Electrochemical Behaviour of Three Macrolides on Pt and Carbon Based Electrodes

“…Even it is known that macrolides are considered to be one of the safest anti-infective groups in clinical use, there are evidence from some side effects such as gastrointestinal, hematologic, liver damage, psychosis regarding Erythromycin, Azithromycin and Clarithromycin. Those reactions are dose -related and are higher with 2000-4000 mg in two doses per day than with 500 À 1000 mg /day [14][15][16][17]. Gastrointestinal reactions represent the most frequent disturbance, occurring in 15 to 20 % of patients treated with erythromycins decreasing to 5 % when they were treated with Azithromycin and Clarithromycin.…”