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Antibiotic-associated encephalopathy.

Shamik Bhattacharyya1, R Ryan Darby2, Pooja Raibagkar2

  • 1From the Department of Neurology (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Brigham and Women's Hospital; Department of Neurology (R.R.D., P.R., L.N.G.C.), Massachusetts General Hospital; and Harvard Medical School (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Boston, MA. sbhattacharyya3@partners.org.

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Summary
This summary is machine-generated.

Antibiotics can cause delirium, a serious hospital complication. This review details three types of antibiotic-associated encephalopathy (AAE) to improve diagnosis and treatment.

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Area of Science:

  • Neuroscience
  • Pharmacology
  • Internal Medicine

Background:

  • Delirium is a frequent and expensive complication in hospitalized patients.
  • Medications are recognized causes of delirium, but antibiotics are an underappreciated class.
  • Antibiotic-associated encephalopathy (AAE) presents unique clinical challenges.

Observation:

  • AAE manifests in three distinct clinical phenotypes.
  • Phenotype 1: Encephalopathy with seizures/myoclonus within days (cephalosporins, penicillin).
  • Phenotype 2: Encephalopathy with psychosis within days (quinolones, macrolides, procaine penicillin).
  • Phenotype 3: Encephalopathy with cerebellar signs/MRI changes weeks later (metronidazole).

Findings:

  • Each phenotype correlates with specific antibiotic neurotoxicity mechanisms.
  • Early recognition of these patterns is crucial for diagnosis.
  • Timely antibiotic discontinuation is key to patient recovery.

Implications:

  • Increased awareness of AAE phenotypes can expedite diagnosis.
  • Prompt cessation of offending antibiotics can reduce patient delirium duration.
  • Understanding antibiotic neurotoxicity improves patient outcomes and reduces healthcare costs.