Always on alert for what will help you eliminate suffering and elevate well-being, I came across this article that’s important to share. Generally we take antibiotics when we’re sick. But did you know that certain ones can damage your central nervous system and cause mental state changes?

Bottom line … to prevent this dilemma check out this Tedx video. Happiness protects you against getting sick. If you want to read more before you check it out, no worries! The link is also at the bottom of the page.

Certainly antibiotics save lives. But wouldn’t it be good to know in advance what to expect if you have to take them? Or to ask your doctor for a different kind if you fall into one of the risk categories for damaging effects?

I thought this table from Medscape.com would be helpful in determining the risk factors associated with any antibiotics you may be taking.

Antimicrobials With Neurotoxic Presentations
 
Antimicrobial
Class
Most Common Presentation of Neurotoxicitya Risk Factors Proposed
Mechanism
Note to
Clinician
Fluoroquinolones[2,5] Acute psychosis
Confusion
Delirium
Hallucinations
Mania
Age (possibly) GABA
antagonism
Recent FDA
safety alert
(use with caution)
Cephalosporins[2,3,6-8]
Most common:
cefepime,
ceftazidime,
cefazolin
Confusion
Delirium
NCSE
Seizures
Age
Preexisting
neurologic
disease
Renal impairment/
improper dose for
patients
creatinine
clearance
GABA
antagonism
(beta-lactam
side chain)
Beta-lactam ring
interaction with
BZD receptor
Watch for
patients who
need renal
dosing
Penicillins[2,6]
Most common:
piperacillin/
tazobactam
Bizarre behavior
Confusion
Delirium
Disorientation
Hallucinations
NCSE
Seizures
Age
Preexisting
neurologic
disease
Renal impairment
(especially creatinine
clearance < 15
mL/min) and/or
dialysis
GABA
antagonism
(beta-lactam
side chain)
Beta-lactam ring
interaction with
BZD receptor
Watch for
patients who
need renal
dosing
Carbapenems[2,6,7,18,19]
Most common:
imipenem,
ertapenem
Cognitive
impairment
Delirium
Hallucinations
Psychosis
syndrome
Seizures
Age
Preexisting
neurologic
disease
Renal impairment
GABA
antagonism
(beta-lactam
side chain)
Beta-lactam ring
interaction with
BZD receptor
Meropenem
and doripenem
are less likely
offenders
Imipenem
metabolite has
prolonged half-
life in the
setting of renal
impairment
Macrolides[2,20]
Most common:
clarithromycin,
erythromycin
Acute psychosis
Delirium
Mania
Age
Cytochrome P450
3A4 substrates
Interactions with
GABA and
glutamate
Change in
cortisol and
prostaglandin
metabolism
Cytochrome
P450 drug
interactions
Case reports of
azithromycin-
associated
delirium in
elderly
patients;
however,
clarithromycin
and
erythromycin
are more
common
offenders
Sulfonamides[2,4,21]
Most common:
TMP/SMX
Acute psychosis
Aseptic meningitis
Hallucinations
Age (especially in
HIV-infected
patients)
Dose
Renal impairment
Unknown More likely in
high-dose
regimens (eg,
Pneumocystis
jirovecii
pneumonia
prophylaxis in
patients with
HIV)
Metronidazole[2,9,22-24] Agitation
Altered mental
status
Cerebellar
dysfunction
Encephalopathy
Ototoxicity
Peripheral
neuropathy
Psychosis
Seizures
Cumulative
exposure
Use in
combination with
disulfiram
Metabolite inhibition of
RNA protein
synthesis
Modification of
GABA receptor
Be aware of
cumulative
exposure
and/or large
doses
Oxazolidinones[2,10,11]
Most common:
linezolid
Delirium
Encephalopathy
Peripheral
neuropathy
Serotonin
syndrome
Age
Alcohol abuse
Concomitant
serotonergic
drugs
Diabetes
Preexisting
neurologic disease
Unknown Increased
postmarketing
reports
Watch for
concomitant
serotonergic
drugs
Azole antifungals[1,12]
Most common:
voriconazole
Delirium
Hallucinations
Serum voriconazole
concentration >
5.5 µg/mL
Unknown Posaconazole
and
fluconazole
less frequent
offenders
Acyclovir[25-27] Confusion
Impaired
consciousness
Dose
Renal impairment
Unknown Postmarketing
reports with
famciclovir and
valacyclovir;
however, both
are less
frequent
offenders than
acyclovir
Oseltamivir[13-16,28,29] Anxiety
Behavioral change
Delirium
Delusions
Convulsions
Encephalitis
Sleep disturbance
Suicidal ideation
Age
Genetic
differences (possibly)
Inhibition of
nicotinic
acetylcholine
receptor
Inhibition of
monoamine
oxidase A
More common
in children
Might be
underreported
Difficult to
distinguish
between
adverse drug
reaction and
symptoms of
the flu
Amantadine and
rimantadine[30]
Anxiety
Behavioral change
Delirium
Hallucinations
Nervousness
Age
Psychiatric
disorder
Renal impairment
Seizure disorder
Unknown Amantadine
more common
offender
Can be seen in
normal doses
in healthy,
young adults

Dr Linda Says …..

happiness is the key to staying healthy

To keep yourself healthy, so you don’t need antibiotics, one of the best things you can do is to be happy! When you’re happy your immune system is strong and defends you against bad bugs that would otherwise make you sick.

Want to be more happy? Check out this Tedx video to find out how. After you watch it please give me your feedback and tell me what you think!