Can antibiotics cause Psychosis? J Clin Psychopharmacol. 2014 Aug.

03.07.2014

Psychotic symptoms emerging after use of antibiotics  have been reported occasionally.  This include psychosis as well as mania with psychotic symptoms ( = antibiomania). Penicillin associated psychosis  is also known as Hoigne syndrome.  How antibiotics cause psychosis is not well understood. It is possible that GABA antagonism ( mainly by fluroquinolone ) , inhibition of prostaglandin synthesis ( = increase in dopamine) , and N-methyl-D-aspartate (NMDA) receptor hypo functioning ( due to depletion of D alanine producing intestinal flora) may be involved.

Infection itself can be associated with psychotic symptoms. UTI in the context of delirium and dementia is a well-known/ common example. Studies suggest that UTI can be the commonest cause for unrecognised medical condition on admission in geriatric patients with psychotic symptoms.

Safinaz Mostafa, and Brian J. Miller conducted a systematic review of cases of antibiotic-associated acute psychosis during treatment of a UTI and evaluated the strength of the association for each case using the guidelines for evaluation of drug-associated events.

They identified 15 cases of antibiotic- associated psychosis during treatment of UTI. These were associated with: fluoroquinolones (n = 8), trimethoprim-sulfamethoxazole  (n = 5), and penicillins (n = 2). Patients were on antibiotics for a mean 4.8 days before psychosis emerged. Two had a previous history of antibiotic related psychosis. All patients had some form of psychiatric history.

Psychotic symptoms included hallucinations (n = 12),  delusions (n = 9), disorganization (n = 5), and catatonia (n = 3) .

80% of cases with trimethoprim- sulphamethoxazole was considered as  highly suggestive of causation. 60% of all cases were considered as  strongly suggesting antibiotic to cause psychosis. 33% were moderately suggestive of this.

In most cases onset and resolution of psychosis occurred within 1 week of initiation or discontinuation of the antibiotics.  Half did not require antipsychotic treatment. In 3 cases, a recurrence of psychosis after re challenge with the same antibiotic provides strong support to the notion that antibiotics could cause psychotic states.

Limitations: Small case series. Cases associated with UTI treatment alone included.

Summary of the article:

Antibiotic-associated psychosis during treatment of urinary tract infections: a systematic review.

Mostafa S, Miller BJ. J Clin Psychopharmacol. 2014 Aug;34(4):483-90

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