Clarithromycin-Induced Delirium in a General Hospital

Abstract

Received June 17, 1997; revised December 17, 1997; accepted January 8, 1998. From the Consultation Liaison Service, North Shore University Hospital, New York University School of Medicine, Manhasett, New York. Address reprint requests to Dr. Mermelstein, 73 Old Pond Road, Great Neck, NY 11023. Copyright 1998 The Academy of Psychosomatic Medicine. Clarithromycin, a new macrolide antibiotic, is effective in the management of a wide range of clinical problems, including outpatient treatment of community-acquired pneumonia, shortening the course of peptic ulcer disease associated with Helicobacter pylori infection and curing previously resistant respiratory infections in immunocompromised patients. Clarithromycin is generally well tolerated, producing fewer gastrointestinal complaints than its parent compound, erythromycin. For these reasons, it is frequently prescribed in adult and pediatric settings. Neurotoxic side effects, including seizures and delirium, have been reported with penicillin and other antibiotics but were not found in the preclinical and clinical trials of clarithromycin or erythromycin. Since then, there have been three brief case reports of alteration in mental status when clarithromycin was added to other medication regimens. Here I report four cases of clarithromycin-induced delirium in a general medical population.