A study published in Neurology suggests that antibiotics may be associated with delirium and other brain issues, which are more severe than previously thought.

Delirium is characterized by mental confusion, hallucinations, and agitation. Medications are a common cause of delirium, but antibiotics aren’t always the first thing doctors think of.

“People who have delirium are more likely to have other complications, go into a nursing home instead of going home after being in the hospital and are more likely to die than people who do not develop delirium,” explained author Shamik Bhattacharyya. “Any efforts we can make to help identify the cause of delirium have the potential to be greatly beneficial.”

Researchers conducted a review of all available scientific studies and found case reports on 391 people who were given antibiotics and later experienced delirium and other brain disorders over a seven-decade period. A total of 54 drugs were employed, spanning 12 distinct antibiotic families and ranging from routinely used antibiotics like sulfonamides and ciprofloxacin to intravenous antibiotics like cefepime and penicillin.

Around 47% had delusions or hallucinations, 14% had seizures, 15% had involuntary muscle jerking, and 5% had lost control of their bodily motions. In addition, in 70% of the patients, the EEG, which monitors electrical activity in the brain, was abnormal. Kidney failure was seen in 25% of those who experienced delirium.

The researchers discovered three types of delirium as well as other brain issues linked to antibiotics.

Seizures were the most common symptom of Type 1, which was linked to penicillin and cephalosporins. Type 2 was related to procaine penicillin, sulfonamides, fluoroquinolones, and macrolides, and was characterized by psychotic symptoms. Both Type 1 and Type 2 had symptoms that appeared within days. Within days of stopping the medications, the symptoms subsided.

Type 3 was only linked to the drug metronidazole and was characterized by abnormal brain scans, decreased muscle coordination, and other indicators of brain dysfunction. It took weeks instead of days for visible symptoms to appear. When the drug was stopped, the symptoms likewise took longer to go.

Bhattacharyya stated that all of the patients had an active infection that could not be ruled out as the cause of the delirium and other neurological abnormalities. In the majority of cases, a scale designed to identify whether side effects may be traced to a drug revealed that an association was possible. The link was most likely when illnesses affecting the central nervous system were excluded.

“More research is needed, but these antibiotics should be considered as a possible cause of delirium,” added Bhattacharyya. “Recognition of different patterns of toxicity could lead to a quicker diagnosis and hopefully prevent of some of the negative consequences for people with delirium and other brain problems.”

Source: 10.1212/WNL.0000000000002455

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