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. 2020 Sep 19:9:100148.
doi: 10.1016/j.bbih.2020.100148. eCollection 2020 Dec.

Psychosis as an adverse effect of antibiotics

Norah Essali  1 , Brian J Miller  1
Affiliations

Psychosis as an adverse effect of antibiotics

Norah Essali et al. Brain Behav Immun Health. .

Abstract

Adverse neuropsychiatric effects of antibiotic medications have been well documented. There is evidence suggesting a direct relationship between acute psychosis and antibiotic exposure. Conversely, the tetracycline antibiotic minocycline has been associated with improvements in psychopathology in patients with psychotic disorders. The purpose of the present study was to investigate the prevalence of spontaneously reported adverse drug reactions (ADRs) of psychotic symptoms in adults for antibiotics and the odds of psychosis compared to minocycline for individual antibiotics and antibiotic classes. We searched the publicly available U.S. F.D.A. Adverse Event Reporting System (FAERS) from inception through March 2020 for which an antibiotic was the suspected agent of an adverse drug reaction (ADR). We investigated 23 different antibiotics, comprising 183,265 adverse event reports and 2955 psychosis ADRs. For individual antibiotics, the prevalence of psychosis ADRs ranged from 0.3 to 3.8%. Fifteen antibiotics were associated with a significantly increased odds of psychosis (OR ​= ​1.67-9.48), including penicillins, fluoroquinolones, macrolides, cephalosporins, and doxycycline. Our results suggest that psychosis is a potential adverse effect of antibiotic treatment, but risks vary by specific agents. Future studies in this area are needed to identify specific underlying biological mechanisms that contribute to these associations. Findings may also inform on clinical decisions regarding the selection of antibiotic therapy in vulnerable patient populations.

Keywords: Adverse drug reaction; Antibiotics; Immune; Minocycline; Psychosis.

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Conflict of interest statement

Dr. Essali has nothing to disclose. Dr. Miller has nothing to disclose for the present work. In the past 12 months, Dr. Miller received research support from Alkermes, 10.13039/100012127Augusta University, 10.13039/100009670NARSAD, the 10.13039/100000025National Institute of Mental Health, and the Stanley Medical Research Institute; and Honoraria from Psychiatric Times.

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