Antibiotic-Associated Psychosis in Children and Adolescents

BACKGROUND: There are case reports of antibiotic-induced psychosis in children and adolescents in the literature, which have not been extensively reviewed. We performed a systematic review of cases of antibiotic-induced acute psychosis in children and adolescents and evaluated the strength of the association for each case. METHODS: We identified cases by searching PubMed, PsycInfo, and Web of Knowledge, and the reference lists of identified reports. We systematically evaluated the quality of the causal relationship between antibiotic treatment for infection and psychosis. Sixteen articles (describing 18 different cases) met the inclusion criteria. RESULTS: The primary findings were: (1) 16 of the reported cases (89%) were "highly suggestive" of a potential causal relationship between antibiotic treatment and psychosis, including 3 cases with a recurrence of psychosis following rechallenge with the same antibiotic, (2) 5 different classes of antibiotics were implicated in this association (fluroquinolones, isoniazid, macrolides, penicillins, and trimethoprim-sulfamethoxazole), (3) for the majority of reported cases, both the onset and resolution of psychosis occurred within 1 week of initiation and discontinuation of the antibiotic, respectively, (4) almost three-quarters of cases (72%) did not require treatment with antipsychotics, and (5) the average age was 10, and 56% of cases were males. CONCLUSIONS: Our findings suggest that acute psychosis is a potential adverse effect of antibiotic treatment in children and adolescents. The mechanism(s) underlying this association remain unclear.