A 66-year-old man in France experienced a frightening episode of antibiomania, a rare side effect of antibiotic treatment characterized by the onset of manic symptoms. The man, who had a history of stress-induced psychiatric episodes 16 years prior, developed a urinary tract infection (UTI). He was initially prescribed levofloxacin, but after five days, his physician switched him to cotrimoxazole to prevent antibiotic resistance. Shortly after starting cotrimoxazole, the man exhibited unusual behaviors, including incoherent babbling, excessive talking, euphoria, inflated self-esteem, and insomnia. These symptoms, indicative of a manic episode, escalated rapidly.
Concerned by the worsening symptoms, doctors switched the man back to levofloxacin, but his manic behavior persisted. He was admitted to the emergency department, where tests revealed acute renal failure but offered no clear explanation for his psychological distress. Suspecting delirium, doctors transferred him to the medical ward for kidney monitoring and continued antibiotic treatment. While his UTI improved, his manic symptoms remained. Further investigations considered conditions like Alzheimer’s disease, but ultimately, a psychiatric consultation was requested.
Given his past psychiatric history, which included episodes of excessive talkativeness, incoherent speech, and hallucinations triggered by stress, the medical team suspected a connection between the antibiotics and his current manic state. The previous episodes had resolved with treatment, suggesting a possible underlying vulnerability or bipolar disorder. The recent manic episode was hypothesized to be primarily linked to cotrimoxazole, due to the timing of symptom onset after starting the medication.
The case highlighted the potential for antibiotics to trigger manic episodes, particularly in individuals with pre-existing psychiatric vulnerabilities, possibly indicating undiagnosed bipolar disorder. This case underscores the need for increased awareness of antibiomania among healthcare professionals, especially when prescribing antibiotics to patients with a history of mood disorders. Prompt recognition and intervention are crucial for effective management of this rare but serious side effect.
To manage the man’s manic symptoms, he was prescribed antipsychotic medication, specifically haloperidol, in addition to medications typically used to treat schizophrenia. Within a week, his symptoms gradually improved, allowing him to be discharged from the hospital. He continued to receive psychiatric follow-up care for several months, during which the haloperidol was gradually tapered off without recurrence of his manic symptoms. This successful treatment outcome further supports the link between the antibiotics and the manic episode.
Antibiotics are essential medications for treating bacterial infections. They work by either killing bacteria or inhibiting their growth. While generally safe and effective, antibiotics can sometimes cause side effects, ranging from mild gastrointestinal issues like nausea and diarrhea to more serious allergic reactions. Antibiomania, though rare, is a significant adverse effect that can manifest as manic symptoms. It’s crucial to remember that antibiotics are ineffective against viral infections such as colds, flu, and COVID-19. Overuse of antibiotics can contribute to antibiotic resistance, a growing public health concern.
The case of the 66-year-old man serves as a reminder of the importance of considering potential psychiatric side effects when prescribing antibiotics, particularly in patients with a history of mood disorders. Early recognition and appropriate intervention with antipsychotic medication can lead to a positive outcome, enabling patients to recover and avoid long-term psychiatric complications. Further research is needed to fully understand the mechanisms underlying antibiomania and identify risk factors.
