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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.
Summary
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.