Transient Psychotic Episode Induced by<b><i>Helicobacter pylori</i></b>Triple Therapy Treatment

Shah, Mitanshu; Subhani, Miral; Rizvon, Kaleem; Mustacchia, Paul

doi:10.1159/000339713

Cited by 15 publications

(13 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A considerable proportion of reports described patients prescribed combination therapy for eradication of H. pylori infection (Feng et al, 2013;Gomez-Gil et al, 1999;Lassnig, 2010;Neff and Kuo, 2002;Shah et al, 2012); other reports involved cases where clarithromycin likely had interactions with other drugs, for example, prednisolone (Finkenbine and Frye, 1998), fluoxetine (Pollak et al, 1995), highly active antiretroviral therapy in AIDS patients (Nightingale et al, 1995;Prime and French, 2001), or a combination of general anesthetics and other antibiotics (Hoigne-Lopfe and Johr, 2006;Przybylo et al, 2005). A considerable proportion of reports described patients prescribed combination therapy for eradication of H. pylori infection (Feng et al, 2013;Gomez-Gil et al, 1999;Lassnig, 2010;Neff and Kuo, 2002;Shah et al, 2012); other reports involved cases where clarithromycin likely had interactions with other drugs, for example, prednisolone (Finkenbine and Frye, 1998), fluoxetine (Pollak et al, 1995), highly active antiretroviral therapy in AIDS patients (Nightingale et al, 1995;Prime and French, 2001), or a combination of general anesthetics and other antibiotics (Hoigne-Lopfe and Johr, 2006;Przybylo et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

The Dangers of Gastritis

Dinca¹,

Skinner²,

Dinca³

et al. 2015

Journal of Nervous &Amp; Mental Disease

View full text Add to dashboard Cite

We present a rare occurrence of brief psychotic episode associated with clarithromycin treatment. This 49-year-old lady with no psychiatric history commenced "triple therapy" for gastritis with Helicobacter pylori infection. After 1 week, a dispensing error became obvious; she was advised to start taking the drug missing for the first week-clarithromycin. Twenty-four hours later, she started acting irrationally and became increasingly disorganized, irritable, and delusional and wrote a 16-page letter to her employer, incoherent but focused on persecutory delusions. She developed auditory and visual hallucinations linked to the death of a neighbor's child. After 6 days, she deteriorated to the point where family sought professional help, and voluntary admission was arranged. The only pharmacological intervention needed was one dose of lorazepam and haloperidol for acute agitation. Twenty-four hours after last clarithromycin dose, she had improved dramatically. In 48 hours, she was "unrecognizable" (her "old self") and was discharged. Follow-up at 1 week showed no active psychosis. For the next 6 months, she did not come again to the attention of mental health services. Clarithromycin-induced psychosis is an extremely rare but recognized side effect with yet unclear pathogenesis. Raising awareness is important in both psychiatric and general practice.

show abstract

Section: Discussionmentioning

confidence: 99%

The Dangers of Gastritis

Dinca¹,

Skinner²,

Dinca³

et al. 2015

Journal of Nervous &Amp; Mental Disease

View full text Add to dashboard Cite

show abstract

“…All cases were identified according to the International Classification of Diseases, Ninth Revision (ICD-9) (eTable 2 in the Supplement). Based on the symptoms (ie, psychosis, delirium, mood, and sleep disturbances) described in the identified case reports, [19][20][21][22][23][24][25] a list of diagnostic codes that describes acute and possibly druginduced clinical conditions for neuropsychiatric events was developed and independently reviewed by 2 local clinical psychiatrists (E.H.M.L. and W.C.C.).…”

Section: Key Pointsmentioning

confidence: 99%

“…18 Apart from clarithromycin monotherapy, neuropsychiatric symptoms were also observed in patients receiving H pylori therapy containing clarithromycin. [19][20][21][22][23][24][25] Despite signal detection implicating clarithromycin as the causative agent of neuropsychiatric events, to our knowledge, no population-based study has been conducted to assess and evaluate the neuropsychiatric risk associated with clarithromycin.…”

mentioning

confidence: 99%

Association Between Acute Neuropsychiatric Events andHelicobacter pyloriTherapy Containing Clarithromycin

Wong

Chui

et al. 2016

JAMA Intern Med

View full text Add to dashboard Cite

IMPORTANCE There is a concern that Helicobacter pylori therapy containing clarithromycin might be associated with acute neuropsychiatric events. OBJECTIVE To examine the association between H pylori therapy containing clarithromycin and acute neuropsychiatric events. DESIGN, SETTING, AND PARTICIPANTS A self-controlled case series study was conducted using the Clinical Data Analysis and Reporting System database in Hong Kong to explore any association. The exposure of interest was H pylori therapy containing clarithromycin in the outpatient setting. Study patients, 18 years or older at cohort entry, must have had both exposure to H pylori therapy containing clarithromycin and their first recorded neuropsychiatric events between January 1, 2003, and December 31, 2012. A post hoc nested case-control analysis was also performed in patients receiving H pylori therapy containing clarithromycin. MAIN OUTCOMES AND MEASURES The primary outcome was composite neuropsychiatric events, while secondary outcomes were psychotic events and cognitive impairment. Risk periods in the self-controlled case series analysis were defined as 14-day preexposure period, current use (days 1-14 since prescription start date) and recent use (days 15-30). Age-adjusted incidence rate ratios (IRR) were estimated using the conditional Poisson regression. RESULTS Of 66 559 patients who had at least 1 outpatient prescription of H pylori therapy containing clarithromycin. Their mean (SD) age at cohort entry was 50.8 (14.8 years); their mean age at first exposure was 55.4 (14.8) years, and 30 910 were male (46.4%). A total of 1824 patients had their first recorded composite neuropsychiatric events during the study period. An increased IRR of 4.12 (35 composite neuropsychiatric events during 72 person-years; 95% CI, 2.94-5.76) during current use was observed but not in recent use (9 events during 82 person-years; IRR, 0.95; 95% CI, 0.49-1.83) and 14-day preexposure period (14 events during 72 person-years; IRR, 1.63; 95% CI, 0.96-2.77) vs baseline (1766 events during 16 665 person-years). Similarly, both the risk of psychotic events and cognitive impairment increased during current use vs baseline, although this subsequently returned to baseline incidence levels during recent use. The crude absolute risks of composite neuropsychiatric events, psychotic events, and cognitive impairment during current use were 0.45, 0.12, and 0.12 per 1000 prescriptions, respectively. The nested case-control analysis also gave similar results to that of the self-controlled case series analysis. CONCLUSIONS AND RELEVANCE This study shows evidence of a short-term increased risk of neuropsychiatric events associated with H pylori therapy containing clarithromycin.

show abstract

“…Antibiomania is a syndrome characterized by confusion, insomnia, mania and/or hallucinations that develops at 2472 hours after antibiotic therapy onset, and subsides within 72 hours after antibiotic discontinuation (1). Its pathophysiology rema ins unknown and is likely multifactorial (3); cases have been described with clarithromycin both as monotherapy (3) Treatment indication, concomitant drugs, patient characteristics and author are included.…”

Section: Discussionmentioning

confidence: 97%