Article Abstract:
Antibiotics can cause psychiatric reactions, although such instances are rare. Such episodes in psychiatric patients taking antibiotics will usually be assumed to arise from psychiatric illness, with no further investigation to determine whether the antibiotic could be the cause. When new antibiotics are tested for use, test groups usually do not include older psychiatric patients or patients who are positive for the human immunodeficiency virus (HIV). However, these drugs may be more reactive in such patients and cause a greater incidence of side effects, including psychiatric reactions, than drug trials might reveal. The cases are presented of two elderly patients with psychiatric histories and one HIV-infected patient who received antibiotic therapy. The first case involved a 76-year-old woman with Parkinson's disease. She required antibiotic therapy and was given trimethoprim-sulfamethoxazole (TMP-SMX), which was later changed to ciprofloxacin. On the fourth day of therapy, she became confused and fearful. Her medications were discontinued and four days later her mental state normalized. In the second case, a 27-year-old HIV-infected woman was given TMP-SMX to treat pneumonia. When she developed a urinary tract infection, it was replaced by ciprofloxacin. Four days later she became hostile. No cause could be found. Ciprofloxacin was discontinued and she began to exhibit normal behavior within four days. The third case involved an 88-year-old man who had a past history of psychiatric problems. He was given TMP-SMX on two occasions for infections. Both times he experienced hallucinations, which stopped once the drug was discontinued. These cases indicate that a higher frequency of psychiatric episodes might occur as a side effect of antibiotic therapy in certain populations. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Therapy with the antibiotic combination of trimethoprim and sulfamethoxazole (TMP-SMX) has been associated with the development of aseptic meningitis, inflammation of the membranes of the spinal cord or brain without microbial (bacterial) infection. A case is described of a 19-year-old woman, who was treated with TMP-SMX for urinary tract infection and developed symptoms of nausea, headache, and weakness. Treatment with TMP-SMX was discontinued and she was given the antibiotic amoxicillin. She developed severe headache, nausea, vomiting, neck stiffness, photophobia or intolerance to light, and weakness. Although the patient developed symptoms of meningitis, she had no evidence of bacterial infection, as indicated by laboratory testing for various bacteria. Treatment with the antibiotic cefotaxime improved her symptoms. The patient was maintained on antibiotics, which were administered intravenously for 14 days, despite the inability to detect bacteria in blood, urine, and cerebrospinal fluid (which is in the spinal cord and brain). She remained well and was without complaints for two months. It was concluded that TMP-SMX may produce aseptic meningitis in some patients. Patients with laboratory findings suggestive of partially treated bacterial meningitis should be maintained on antibiotics for a complete course of therapy, despite negative tests for bacterial infection. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
A patient who was seen in an emergency room complaining of crampy right upper quadrant abdominal pain was treated with ciprofloxacin, a fluoroquinolone antibiotic. Two days later, she developed severe headache, a high fever, neck pain and stiffness. Her white blood cell count was high (indicating infection) and an examination of her spinal fluid showed the presence of large numbers of eosinophils (a white blood cell that usually increases in the presence of allergic reactions). The patient's condition was diagnosed as eosinophilic meningitis. The ciprofloxacin was discontinued and within 24 hours her symptoms abated. Although the fluoroquinolone antibiotics have been associated with certain disorders of the central nervous system, including dizziness, headache, restlessness, tremor and insomnia, the authors believe that this is the first reported case of the drug producing eosinophilic meningitis.
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