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Antimicrobial-induced mania (antibiomania): a review of spontaneous reports
Ahmed Abouesh1, Chip Stone, William R Hobbs
1Southern Virginia Mental Health Institute, Danville, VA 24541, USA.
Abstract:
The authors reviewed reported cases of antibiotic-induced manic episodes by means of a MEDLINE and PsychLit search for reports of antibiotic-induced mania. Unpublished reports were requested from the World Health Organization (WHO) and the Food and Drug Administration (FDA). Twenty-one reports of antimicrobial-induced mania were found in the literature. There were 6 cases implicating clarithromycin, 13 implicating isoniazid, and 1 case each implicating erythromycin and amoxicillin. The WHO reported 82 cases. Of these, clarithromycin was implicated in 23 (27.6%) cases, ciprofloxacin in 12 (14.4%) cases, and ofloxacin in 10 (12%) cases. Cotrimoxazole, metronidazole, and erythromycin were involved in 15 reported manic episodes. Cases reported by the FDA showed clarithromycin and ciprofloxacin to be the most frequently associated with the development of mania. Statistical analysis of the data would not have demonstrated a significant statistical correlative risk and was therefore not undertaken. Patients have an increased risk of developing mania while being treated with antimicrobials. Although this is not a statistically significant risk, physicians must be aware of the effect and reversibility. Further research clearly is required to determine the incidence of antimicrobial-induced mania, the relative risk factors of developing an antimicrobial-induced manic episode among various demographic populations, and the incidence of patients who continue to have persistent affective disorders once the initial episode, which occurs while the patient is taking antibiotics, subsides. The authors elected to name this syndrome "antibiomania."
Insights
Antibiotics can trigger manic episodes, a condition termed "antibiomania." While not statistically significant, this risk necessitates physician awareness of potential side effects during antimicrobial treatment.
Area of Science:
- Neuropsychiatry
- Pharmacology
- Clinical Medicine
Background:
- Antimicrobial agents are widely prescribed.
- Manic episodes are a recognized psychiatric condition.
- The link between antibiotics and mania requires further investigation.
Purpose of the Study:
- To review and consolidate reported cases of antibiotic-induced manic episodes.
- To identify specific antibiotics associated with mania.
- To raise awareness of this potential adverse effect.
Main Methods:
- Systematic literature search of MEDLINE and PsychLit databases.
- Inclusion of published reports and requests for unpublished data from WHO and FDA.
- Review of case reports implicating various antimicrobial agents.
Main Results:
- Twenty-one literature cases identified: clarithromycin (6), isoniazid (13), erythromycin (1), amoxicillin (1).
- WHO data: 82 cases, with clarithromycin (27.6%), ciprofloxacin (14.4%), and ofloxacin (12%) most implicated.
- FDA data also highlighted clarithromycin and ciprofloxacin.
- No statistically significant correlative risk identified, but an increased risk noted.
Conclusions:
- Patients face an increased risk of mania during antimicrobial treatment.
- Physicians should be aware of this potential adverse effect and its reversibility.
- Further research is needed to determine incidence, risk factors, and persistent mood disorders.