Department of Neurology, Ophthalmology and Genetics, University of Genoa, Via de Toni 5, 16132 Genoa, Italy.
J Clin Neurosci. 2011 Mar;18(3):313-8. doi: 10.1016/j.jocn.2010.08.014.
Clarithromycin is a relatively new antibiotic of the macrolide family heralded for an improved side effect profile, dosing schedule, and microbiological activity relative to its parent compound, erythromycin. We review the literature on clarithromycin-induced neurotoxicity in adults and present an illustrative case. A total of 38 patients with clarithromycin-induced neurotoxicity have been reported. The average age of patients was 51.3 years (range: 19-87 years) with females comprising 52.6% of patients. Psychiatric illness was the most common comorbidity, while only two patients had renal failure. Clarithromycin had been prescribed for respiratory infections in most patients, and only two patients were receiving more than 1000 mg/day of antibiotic. The symptoms started 1 day to 10 days after starting clarithromycin (mean: 5 days). A total of 71% of patients were under treatment with concomitant medication, and eight patients were undergoing treatment with psychoactive drugs. Patients had a very good outcome after clarithromycin was discontinued, but medication with neuroleptics or benzodiazepine was required for 58% of patients in the acute phase. Only four patients underwent an electroencephalogram (EEG). Our illustrative patient was a 74-year-old woman with clarithromycin-induced delirium due to non-convulsive status epilepticus (NCSE). Her clinical symptoms and electroencephalogram (EEG) readings dramatically improved after discontinuation of clarithromycin. The mechanism underlying the central nervous system side effects remains unclear. We suggest including an EEG in the diagnostic procedures of patients under treatment with clarithromycin who develop features of neurotoxicity because an EEG can help to differentiate patients with psychiatric illness from those with encephalopathy or epilepsy. Because of the widespread use of clarithromycin, clinicians should be aware of its neurotoxicity. Early detection of clarithromycin-induced neurotoxicity and discontinuation of the drug may result in full recovery.
克拉霉素是一种新型大环内酯类抗生素，与母体化合物红霉素相比，具有改善的副作用谱、给药方案和微生物学活性。我们复习了成人克拉霉素相关神经毒性的文献，并报告了一个病例。总共报道了 38 例克拉霉素引起的神经毒性患者。患者的平均年龄为 51.3 岁（范围：19-87 岁），女性占患者的 52.6%。精神疾病是最常见的合并症，只有两名患者患有肾衰竭。大多数患者接受克拉霉素治疗呼吸道感染，只有两名患者每天接受超过 1000 毫克的抗生素。症状在开始使用克拉霉素后 1 天至 10 天（平均：5 天）出现。共有 71%的患者同时接受其他药物治疗，8 名患者正在接受精神药物治疗。停用克拉霉素后，患者的病情迅速好转，但在急性期，58%的患者需要使用神经阻滞剂或苯二氮䓬类药物。只有 4 名患者接受了脑电图（EEG）检查。我们的病例是一名 74 岁女性，因非惊厥性癫痫持续状态（NCSE）导致克拉霉素引起的意识障碍。停用克拉霉素后，她的临床症状和脑电图（EEG）读数显著改善。中枢神经系统副作用的机制仍不清楚。我们建议对接受克拉霉素治疗并出现神经毒性特征的患者进行脑电图检查，因为脑电图有助于区分精神病患者与脑病或癫痫患者。由于克拉霉素的广泛应用，临床医生应注意其神经毒性。早期发现克拉霉素引起的神经毒性并停用该药物可能会导致完全康复。
