Antibiomania - Revision history

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2026-03-22T08:46:15Z

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← Revisión anterior		Revisión del 08:46 22 mar 2026
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	Patients typically present with acute onset manic symptoms within days (often 1-5 days) of initiating antibiotic therapy<ref>Ambrosetti J, et al. BMC Psychiatry. 2021;21:399.</ref>. Key features include:		Patients typically present with acute onset manic symptoms within days (often 1-5 days) of initiating antibiotic therapy<ref>Ambrosetti J, et al. BMC Psychiatry. 2021;21:399.</ref>. Key features include:

	*~~'''~~Mood changes:~~'''~~ Elevated, expansive, or markedly irritable mood		*Mood changes: Elevated, expansive, or markedly irritable mood
	*~~'''~~Behavioral changes:~~'''~~ Increased goal-directed activity, restlessness, hypersexuality, or impulsivity		*Behavioral changes: Increased goal-directed activity, restlessness, hypersexuality, or impulsivity
	*~~'''~~Speech:~~'''~~ Pressured speech		*Speech: Pressured speech
	*~~'''~~Sleep:~~'''~~ Decreased need for sleep without fatigue		*Sleep: Decreased need for sleep without fatigue
	*~~'''~~Cognition:~~'''~~ Racing thoughts, distractibility		*Cognition: Racing thoughts, distractibility
	*~~'''~~Psychotic features~~'''~~: Grandiose or paranoid delusions (less common)		*Psychotic features: Grandiose or paranoid delusions (less common)

	Crucially, many patients have no prior psychiatric history, though the condition can also precipitate mania in those with underlying bipolar disorder.		Crucially, many patients have no prior psychiatric history, though the condition can also precipitate mania in those with underlying bipolar disorder.
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	===Diagnostic Workup===		===Diagnostic Workup===
	*~~'''~~Laboratory~~'''~~: CBC, CMP, TSH, free T4, cortisol level, UA, urine toxicology screen		*Laboratory: CBC, CMP, TSH, free T4, cortisol level, UA, urine toxicology screen
	*~~'''~~Imaging~~'''~~: CT head if first manic episode, atypical presentation, or focal neurological findings to rule out organic causes		*Imaging: CT head if first manic episode, atypical presentation, or focal neurological findings to rule out organic causes
	*~~'''~~ECG:~~'''~~ If sympathomimetic toxidrome suspected or before administering antipsychotics		*ECG: If sympathomimetic toxidrome suspected or before administering antipsychotics

	Key diagnostic clue is the temporal relationship between antibiotic initiation and symptom onset.		Key diagnostic clue is the temporal relationship between antibiotic initiation and symptom onset.
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	==Management==		==Management==
	===Immediate Interventions===		===Immediate Interventions===
	*~~'''~~Discontinue offending antibiotic:~~'''~~ Consult with primary team regarding alternative antimicrobial agents for the underlying infection		*Discontinue offending antibiotic: Consult with primary team regarding alternative antimicrobial agents for the underlying infection
	===Agitation Control===		===Agitation Control===
	* [[Lorazepam]] 1-2 mg PO/IV/IM (titrated to effect)		* [[Lorazepam]] 1-2 mg PO/IV/IM (titrated to effect)

Ostermayer: /* Background */

2026-02-02T15:29:26Z

Background

← Revisión anterior		Revisión del 15:29 2 feb 2026
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	First coined in 2002 in the Journal of Clinical Psychopharmacology, antibiomania describes a condition where antimicrobial agents induce manic or mixed affective episodes. The initial literature review identified 21 cases, with [[clarithromycin]] being the most frequently implicated agent, followed by [[isoniazid]], [[ciprofloxacin]], and [[ofloxacin]]<ref>Abouesh, A et al. Antimicrobial-induced mania (antibiomania): a review of spontaneous reports. J Clin Psychopharmacol. 2002 Feb;22(1):71-81. PMID: 11799346.</ref>. World Health Organization (WHO) pharmacovigilance data later expanded this to 82 cases, with clarithromycin implicated in 27.6% of reports<ref>Ambrosetti J, et al. Antibiomania: a case report of clarithromycin and amoxicillin-clavulanic acid induced manic episodes separately. BMC Psychiatry. 2021;21:399.</ref>.		First coined in 2002 in the Journal of Clinical Psychopharmacology, antibiomania describes a condition where antimicrobial agents induce manic or mixed affective episodes. The initial literature review identified 21 cases, with [[clarithromycin]] being the most frequently implicated agent, followed by [[isoniazid]], [[ciprofloxacin]], and [[ofloxacin]]<ref>Abouesh, A et al. Antimicrobial-induced mania (antibiomania): a review of spontaneous reports. J Clin Psychopharmacol. 2002 Feb;22(1):71-81. PMID: 11799346.</ref>. World Health Organization (WHO) pharmacovigilance data later expanded this to 82 cases, with clarithromycin implicated in 27.6% of reports<ref>Ambrosetti J, et al. Antibiomania: a case report of clarithromycin and amoxicillin-clavulanic acid induced manic episodes separately. BMC Psychiatry. 2021;21:399.</ref>.

	Clarithromycin is commonly prescribed for [[H. pylori]] eradication triple therapy and respiratory infections, making it a frequent culprit in clinical practice. Other implicated agents include [[erythromycin]], [[amoxicillin]], [[cotrimoxazole]], and [[metronidazole]]. The exact pathophysiology remains unclear, though hypotheses include GABA receptor antagonism, altered monoaminergic neurotransmission, and interactions with the gut microbiome affecting the gut-brain axis<ref>Carrasco JP, Aguilar EJ. Antibiomania: A Case Report of a Manic Episode Potentially Induced by the Interaction of Clarithromycin and Amoxicillin during H. Pylori Eradication Therapy. Actas Esp Psiquiatr. 2024;52(1):57-59. PMID: 38416487.</ref>.		The exact pathophysiology remains unclear, though hypotheses include GABA receptor antagonism, altered monoaminergic neurotransmission, and interactions with the gut microbiome affecting the gut-brain axis<ref>Carrasco JP, Aguilar EJ. Antibiomania: A Case Report of a Manic Episode Potentially Induced by the Interaction of Clarithromycin and Amoxicillin during H. Pylori Eradication Therapy. Actas Esp Psiquiatr. 2024;52(1):57-59. PMID: 38416487.</ref>.

	==Clinical Features==		==Clinical Features==

Ostermayer at 15:28, 2 February 2026

2026-02-02T15:28:49Z

@@ Línea 1: / Línea 1: @@
 ==Background==
-First coined in 2002, in Journal of Clinical Pharmacology as a condition where antibiotics are associated with psychological changes, specifically mania. 21 cases were reported with [[clarithromycin]] being the most common and often prescribed for [[H. pylori]] treatment<ref>Abouesh, A et al. Antmicrobial-induced mania (antbiomania): a review of spontaneous reports. J Clin Psychopharmacol. 2002 Feb;22(1):71-81. PMID: 11799346.</ref>
+First coined in 2002 in the *Journal of Clinical Psychopharmacology*, antibiomania describes a condition where antimicrobial agents induce manic or mixed affective episodes. The initial literature review identified 21 cases, with [[clarithromycin]] being the most frequently implicated agent, followed by [[isoniazid]], [[ciprofloxacin]], and [[ofloxacin]]<ref>Abouesh, A et al. Antimicrobial-induced mania (antibiomania): a review of spontaneous reports. J Clin Psychopharmacol. 2002 Feb;22(1):71-81. PMID: 11799346.</ref>. World Health Organization (WHO) pharmacovigilance data later expanded this to 82 cases, with clarithromycin implicated in 27.6% of reports<ref>Ambrosetti J, et al. Antibiomania: a case report of clarithromycin and amoxicillin-clavulanic acid induced manic episodes separately. BMC Psychiatry. 2021;21:399.</ref>.
 ==Clinical Features==
 ==Differential Diagnosis==
-==Evaluation==
+===Diagnostic Workup===
 ==Management==
 ==Disposition==
 ==See Also==
+* [[Mania]]
 ==External Links==
+*[https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03397-7|BMC Psychiatry Case Report: Clarithromycin and Amoxicillin-Clavulanic Acid Induced Mania]
 ==References==
@@ Línea 27: / Línea 89: @@
 [[Category:Pharmacology]]

Ostermayer: Created page with "==Background== First coined in 2002, in Journal of Clinical Pharmacology as a condition where antibiotics are associated with psychological changes, specifically mania. 21 cas..."

2017-11-27T03:25:52Z

Created page with "==Background== First coined in 2002, in Journal of Clinical Pharmacology as a condition where antibiotics are associated with psychological changes, specifically mania. 21 cas..."

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==Background==
First coined in 2002, in Journal of Clinical Pharmacology as a condition where antibiotics are associated with psychological changes, specifically mania. 21 cases were reported with [[clarithromycin]] being the most common and often prescribed for [[H. pylori]] treatment<ref>Abouesh, A et al. Antmicrobial-induced mania (antbiomania): a review of spontaneous reports. J Clin Psychopharmacol. 2002 Feb;22(1):71-81. PMID: 11799346.</ref>

==Clinical Features==

==Differential Diagnosis==

==Evaluation==

==Management==

==Disposition==

==See Also==

==External Links==

==References==
<references/>

[[Category:Pharmacology]]