Clarithromycin-induced mania in a child

Area of Science:

• Pediatric Psychiatry
• Pharmacovigilance
• Infectious Diseases

Background:

• Clarithromycin is a widely prescribed macrolide antibiotic for pediatric respiratory tract infections.
• Macrolide antibiotics are generally considered safe, with gastrointestinal upset being the most common side effect.
• Psychiatric side effects, such as mania, are exceptionally rare in pediatric patients using clarithromycin.

Observation:

• A pediatric case presented with acute onset of typical manic symptoms, including elevated mood, decreased need for sleep, and pressured speech.
• The patient's symptoms emerged during a course of clarithromycin treatment for a respiratory infection.
• Notably, the child had no prior psychiatric history or known genetic predisposition to bipolar disorder or mania.

Findings:

• The presented case demonstrates a direct association between clarithromycin use and the development of manic symptoms in a pediatric patient.
• The clinical presentation of mania in this child closely mirrored that observed in adult patients experiencing this rare side effect.
• The absence of genetic vulnerability underscores the potential of clarithromycin to independently trigger manic episodes.

Implications:

• This case underscores the importance of considering rare psychiatric side effects, like mania, in pediatric patients prescribed clarithromycin.
• Clinicians should maintain a high index of suspicion for mood disturbances during clarithromycin therapy in children.
• Further pharmacovigilance studies are warranted to better understand the incidence and risk factors for clarithromycin-induced mania in pediatric populations.