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Clarithromycin-induced mania in two patients with AIDS

S D Nightingale1, F T Koster, G J Mertz

  • 1University of Texas Southwestern Medical Center at Dallas, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 1, 1995
PubMed

Insights

Acute psychosis is a rare side effect of clarithromycin in patients with acquired immunodeficiency syndrome (AIDS). Discontinuing the antibiotic resolves psychosis, indicating a direct link between clarithromycin and psychosis in AIDS patients.

Area of Science:

  • Infectious Diseases
  • Neuropsychiatry

Background:

  • Disseminated Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS).
  • Clarithromycin is a key antibiotic used in the treatment of MAC infections.

Observation:

  • Two patients with AIDS receiving clarithromycin for disseminated MAC infection developed acute psychosis.
  • The psychosis symptoms subsided upon cessation of clarithromycin therapy.
  • Psychotic episodes reappeared when clarithromycin treatment was reinstituted.

Findings:

  • Clarithromycin can induce acute psychosis as an adverse effect in patients with AIDS.
  • The psychosis is directly attributable to clarithromycin, as evidenced by its recurrence upon re-exposure.

Implications:

  • Clinicians should consider clarithromycin-induced psychosis in AIDS patients presenting with acute psychotic symptoms.
  • Early recognition and discontinuation of clarithromycin can lead to a full recovery from psychosis.
  • This highlights the importance of monitoring for neuropsychiatric adverse events during antibiotic therapy in immunocompromised individuals.

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