Psychosomatics 48:87, January-February
doi: 10.1176/appi.psy.48.1.87
© 2007 Academy of Psychosomatic Medicine
Exacerbation of Psychotic Symptoms Associated With Gatifloxacin
Roy R. Reeves, D.O., Ph.D., Chief of Mental Health (11M) G.V. (Sonny) Montgomery VA Medical Center Jackson, Miss.
TO THE EDITOR: Gatifloxacin is a widely-prescribed 8-methoxy-fluoroquinolone antibiotic effective against a wide range of gram-positive, gram-negative, and atypical micro-organisms. It is generally well tolerated, with low rates of CNS adverse effects. Described here are two patients who experienced exacerbation of psychotic symptoms associated with gatifloxacin treatment.
Case 1
A 60-year-old man with a history of schizoaffective disorder and type II diabetes was doing well on sertraline 50 mg daily, quetiapine 200 mg bid, and glyburide 5 mg daily. He had not been hospitalized in 5 years and had not had hallucinations for several months. He developed bronchitis, and gatifloxacin 400 mg q am was started. Late on the next day, he began hearing voices and experiencing command hallucinations, which resulted in his hospitalization. On admission, gatifloxacin was discontinued because it was noted that it may have a possible interaction with glyburide, and a cephalosporin was substituted. His hallucinations gradually resolved over the next 36 hours, and he was discharged on his original medications. He has not had a significant subsequent recurrence of these symptoms.
Case 2
A 62-year-old man with paranoid schizophrenia treated with Risperdal Consta® 25 mg IM q 2 weeks was compliant with treatment and stable enough to live independently. He was started on gatifloxacin 400 mg daily after he developed a urinary tract infection. On Day 2 of treatment, he began to feel much more paranoid than usual. The following day, he complained that he was being spied on and that the TV was being used to monitor him, and he began hearing voices. By that time, his urine cultures revealed that the organism causing his infection was not sensitive to gatifloxacin, and he was changed to amoxicillin. His psychotic symptoms lessened noticeably over the next 2 days, and he reverted to his baseline status without any changes in his psychotropic medications.
Discussion
In these two cases, exacerbation of psychotic symptoms appeared to occur concomitantly with initiation of treatment with gatifloxacin and resolve with discontinuation of the drug. The only previously reported cases of psychosis with gatifloxacin treatment have been in elderly patients, one an 89-year-old woman,1 and the other, an 86-year-old man.2 Psychosis has been reported with fluorquinolone use in younger patients; these drugs include ciprofloxacin and ofloxacin.3 Disturbances of the CNS occur at an overall frequency of 1%–2% in patients taking fluoroquinolones (but may range from 0.2%–11% for individual agents), and symptoms include headache, drowsiness, dizziness, restlessness, insomnia, agitation, and vision changes.3 Although CNS adverse effects of gatifloxacin are generally mild, an 87-year-old woman developed seizures and myoclonus,4 and a 69-year-old man developed delirium while receiving the drug.5
It may be seen that cases involving gatifloxacin and psychosis or delirium have involved patients age 60 or older, which possibly suggests that this age-group is more vulnerable. The CNS effects of fluoroquinolones are thought to be due to the drugs’ ability to inhibit GABAA receptors and possibly bind to NMDA receptors.3 Clinicians should be aware of the potential of gatifloxacin and other fluoroquinolones to precipitate or exacerbate psychotic symptoms.
REFERENCES
- Satyanarayana S, Campbell B: Gatifloxacin-induced delirium and psychosis in an elderly demented woman. J Am Geriatr Soc 2006; 54:871[Medline]
- Reeves RR: Gatifloxacin precipitation of psychosis in Alzheimer disease. Am J Geriatr Psychiatry 2003; 11:470–471[CrossRef][Medline]
- Fish DN: Fluoroquinolone: adverse effects and drug interactions. Pharmacotherapy 2001; 21:253S-272S[CrossRef]
- Marinella MA: Myoclonus and generalized seizures associated with gatifloxacin treatment. Arch Intern Med 2001; 161: 2261-2262
- Sumner CL, Elliott RL: Delirium associated with gatifloxacin. Psychosomatics 2003; 44:85–86[Free Full Text]
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