Hallucinogenic clarithromycin
Antibiotics caused hallucinations in a Swiss resident
Tatiana Shcheglova, Health Mail.ru
Antibiotics caused hallucinations in a man from Switzerland. This clinical case was reported in the journal BMC Psychiatry (Meszaros et al., Antibiomania: a case report of clarithromycin and amoxicillin-clavulanic acid induced manic episodes separately) by the staff of the Department of Psychiatry of the Faculty of Medicine of the University of Geneva (Switzerland).
A previously mentally and physically healthy, non-smoking and non-drinking 50-year-old man was diagnosed with bacterial pneumonia and prescribed a course of the antibiotic "Augmentin" (amoxicillin + clavulanic acid). It was the first time in his entire life that a man took an antibiotic. Since there was no improvement two days later, the patient was prescribed another antibiotic, clarithromycin.
Two days later, the man's relatives noticed that his behavior had changed — he suddenly became very talkative, irritable, energetic, was in high spirits all the time and talked about his conversations with God. Relatives brought the patient to the hospital, from where he was sent to the department of emergency psychiatric care. There, the patient told the doctors that already on the first night after taking the antibiotic, it seemed to him that he was dying, and he had auditory hallucinations — it seemed to the man that God was talking to him, who told him that he was chosen for a special mission.
Doctors diagnosed the patient with antibiomania — a rare little-known side effect of antibiotics, in which the patient develops an attack of psychosis as a result of taking these drugs. The term "antibiomania" was proposed in 2002 by the authors of a review published in the Journal of Clinical Psychopharmacology. At that time, 21 reports of episodes of mania after taking antibiotics were found in the medical literature, and another 82 such cases were reported by the World Health Organization. The authors of another review on this topic, published in 2017 in the Journal of Affective Disorders, reported 47 cases of antibiomania, with the youngest patient being only three years old. Most often, such an adverse reaction occurs when taking clarithromycin, as well as ciprofloxacin and ofloxacin. The biological reasons for the development of mania against the background of taking antibiotics are not yet clear.
As for the Swiss patient, after he stopped taking clarithromycin and took lorazepam (an anti-anxiety medication), his mental state improved and the man was discharged home. However, since it was necessary to continue treatment for pneumonia, he started taking Augmentin again — and the symptoms of psychosis immediately returned. Therefore, the man eventually had to completely abandon antibiotic therapy.
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