Consider Antibiotics as a Potential Cause of CNS Effects

Explore how antibiotics might contribute to central nervous system (CNS) effects.

1 minute read

It's often a surprise when antibiotics cause adverse CNS effects (confusion, delirium, seizures, etc).

About 3% of patients on quinolones have insomnia, confusion, hallucinations, or other CNS effects. Now FDA will require new warnings about quinolone adverse effects. But other antibiotics can cause problems too.

For example, penicillins, cephalosporins, and carbapenems (imipenem, etc) are linked to seizures, especially in patients with renal impairment, epilepsy, or on high IV doses.

NPS-adv

And recent evidence suggests that treating H. pylori with clarithromycin might lead to psychosis and cognitive impairment. The good news is most of these effects are rare and reversible.

Identify patients at higher risk (children, elderly, impaired renal function, etc), and adjust the antibiotic dose if needed.
If CNS effects occur, consider whether an antibiotic is the culprit, side effects typically occur within days of starting treatment.

But don't brush off other potential causes, neurological conditions, electrolyte imbalances, or even the infection itself.

Switch to another antibiotic if needed and monitor to see if symptoms improve. CNS effects due to antibiotics generally resolve within about 5 days after stopping the antibiotic.

NPS-adv

References

Bhattacharyya S, Darby RR, Raibagkar P, Gonzalez Castro LN, Berkowitz AL. Antibiotic-associated encephalopathy. Neurology. 2016;86(10):963-971.
Grill MF, Maganti RK. Neurotoxic effects associated with antibiotic use: management considerations. Br J Clin Pharmacol. 2011;72(3):381-393.
Wong AY, Wong IC, Chui CS, et al. Association Between Acute Neuropsychiatric Events and Helicobacter pylori Therapy Containing Clarithromycin. JAMA Intern Med. 2016;176(6):828-834.

This note has been edited and reviewed by the pharmacy doctors on NPS team.