Clinical manifestation of macrolide antibiotic toxicity in CKD and dialysis patients

Area of Science:

• Pharmacology
• Nephrology
• Neuroscience

Background:

• Macrolide antibiotics like erythromycin, clarithromycin, and azithromycin are frequently used for respiratory infections.
• Emerging evidence suggests macrolides possess immunomodulatory effects, warranting attention to their adverse effects.
• The widespread use of macrolides necessitates a thorough understanding of their safety profile, particularly in vulnerable populations.

Purpose of the Study:

• To report two cases of end-stage renal disease (ESRD) patients experiencing hallucinations after clarithromycin use.
• To discuss the neurotoxicity of macrolide antibiotics, specifically clarithromycin.
• To review pharmacokinetic properties and toxicities of macrolides in patients with chronic kidney disease (CKD) and ESRD.

Main Methods:

• Case report of two ESRD patients presenting with visual hallucinations.
• Review of existing literature on clarithromycin neurotoxicity and macrolide pharmacokinetics in renal impairment.
• Clinical observation of symptom resolution upon drug discontinuation.

Main Results:

• Two ESRD patients developed vivid visual hallucinations, described as images of worms, after clarithromycin administration.
• Hallucinations resolved completely after cessation of clarithromycin, consistent with previous reports of clarithromycin-induced neurotoxicity.
• Discussion of macrolide pharmacokinetic alterations and increased toxicity risk in CKD and ESRD patients.

Conclusions:

• Clarithromycin can induce neurotoxic effects, including visual hallucinations, in ESRD patients.
• Physicians should be vigilant for potential central nervous system adverse effects of macrolides in patients with impaired renal function.
• Further research into macrolide safety in renal impairment is warranted to optimize patient management and prevent adverse events.