Clarithromycin-induced Seizures and Status Epilepticus

Abstract

Clarithromycin is a commonly used antibiotic. Neuropsychiatric adverse effects are recognized, but the occurrence of seizures and status epilepticus (SE) has been rarely reported. We report the case of an elderly patient who developed generalized tonic-clonic seizures (GTCS) followed by nonconvulsive status epilepticus (NCSE), 2 days after starting clarithromycin. Other causes of seizures were excluded by magnetic resonance imaging (MRI) of the brain, CSF analysis, and routine laboratory studies, thus establishing the causal role of clarithromycin. Clarithromycin was stopped and parenteral antiepileptic drugs started, which controlled the status. In the elderly, symptoms like delirium, drowsiness, confusion, or seizures can occur due to an underlying systemic disease, brain pathology, or adverse effects of medications, all of which must be correctly differentiated. This case illustrates the occurrence of seizures and SE due to clarithromycin. Awareness about this possibility will help physicians recognize and treat such situations promptly. How to cite this article: Seetharam R, Iyer RB, Nooraine J, Ramachandran J. Clarithromycin-induced Seizures and Status Epilepticus. Indian J Crit Care Med 2021;25(8):945-947.

Keywords: Adverse effects; Antibiotics; Clarithromycin; Neurotoxicity; Nonconvulsive status epilepticus.

Figs 1A to C

EEG was done in a 71-year-old with two episodes of seizures within 24 hours depicted in the bipolar montage (1–70 Hz). Initial EEG was normal (A). Three days later when he presented with a confusional state, EEG was repeated, which showed features of NCSE in the form of generalized rhythmic theta activity intermixed with spikes (B). He was treated with injection lorazepam that controlled the NCSE with the reappearance of background activity with an increased nonspecific slowing in comparison with baseline (C)