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Delirium in the elderly resulting from azithromycin therapy
Lawrence A Cone1, Lester Padilla, Barbara E Potts
1Department of Medicine, Eisenhower Medical Center, Rancho Mirage, California, USA.
Background:
Azithromycin, a semi-synthetic azalide antibiotic, is a macrolide that thus far has not shared the neuropsychiatric side effects of other macrolides such as erythromycin and clarithromycin.
Methods:
We now report significant delirium associated with conventional dosing of azithromycin in two geriatric patients who were being treated for lower respiratory tract infection.
Results:
The onset of delirium was apparent within 72 hours of initiating azithromycin therapy and lasted 48 to 72 hours after discontinuing treatment with the drug.
Conclusions:
In contrast to the adverse central nervous system symptoms associated with clarithromycin, those induced by azithromycin seem to take longer to resolve, perhaps based upon the longer elimination half-life of the latter antimicrobial, particularly in geriatric women.
Insights
Azithromycin (an azalide antibiotic) can cause delirium in geriatric patients, even at standard doses. This side effect may persist longer than expected due to the drug
Area of Science:
- Pharmacology
- Geriatric Medicine
- Infectious Diseases
Background:
- Azithromycin, a widely used azalide antibiotic, is generally considered to have a favorable neuropsychiatric side effect profile compared to other macrolides.
- Previous reports have not extensively documented central nervous system (CNS) adverse events associated with azithromycin therapy.
Observation:
- Two elderly patients developed significant delirium during treatment with conventional doses of azithromycin for lower respiratory tract infections.
- The onset of delirium occurred within 72 hours of starting azithromycin.
Findings:
- Delirium resolved 48 to 72 hours after azithromycin discontinuation.
- The prolonged resolution time suggests a potential link between azithromycin and persistent CNS effects in the elderly.
Implications:
- Clinicians should be aware of the potential for azithromycin-induced delirium in geriatric populations.
- The longer elimination half-life of azithromycin, particularly in elderly women, may contribute to delayed symptom resolution.
- Further investigation into azithromycin's CNS effects in the elderly is warranted.