Sternbach H, State R
Department of Psychiatry, UCLA-Neuropsychiatric Institute, USA.
Harv Rev Psychiatry. 1997 Nov-Dec;5(4):214-26. doi: 10.3109/10673229709000304.
Antibiotics are the second most commonly prescribed class of medication in the United States. An awareness and understanding of their potential effects on the central nervous system and their interactions with psychotropic agents is important in the evaluation of neuropsychiatric signs and symptoms in patients. Since the introduction of antibiotic agents in the 1930s, numerous (primarily anecdotal) reports have appeared describing psychiatric side effects ranging from anxiety and panic to major depression, psychosis, and delirium in patients with and without a premorbid psychiatric history. Risk factors have included prior psychopathology, coexisting medical conditions, slow acetylator status, advanced age, concomitant medications, and increased permeability of the blood-brain barrier, as well as high antibiotic dosage and intrathecal or intravenous administration. Psychiatric toxicity may result from various mechanisms of action, including antagonism of gamma-aminobutyric acid or pyridoxine, adverse interactions with alcohol, or inhibition of protein synthesis. Adverse pharmacokinetic and pharmacodynamic interactions between antibiotics and concomitant medications including lithium, benzodiazepines, carbamazepine, valproate, neuroleptics, antidepressants, methadone, and disulfiram have also been reported. Because such effects are often not recognized by clinicians, accurate epidemiologic data on their incidence are not available.
抗生素是美国处方量第二大的药物类别。了解并认识到它们对中枢神经系统的潜在影响以及与精神药物的相互作用，对于评估患者的神经精神症状很重要。自20世纪30年代引入抗生素以来，已有大量（主要是轶事性的）报告描述了有或无前驱精神病史患者的精神副作用，范围从焦虑和惊恐到重度抑郁、精神病和谵妄。危险因素包括既往精神病理学、并存的医疗状况、慢乙酰化状态、高龄、同时使用的药物、血脑屏障通透性增加，以及高剂量抗生素和鞘内或静脉给药。精神毒性可能由多种作用机制导致，包括γ-氨基丁酸或吡哆醇拮抗、与酒精的不良相互作用或蛋白质合成抑制。还报告了抗生素与包括锂盐、苯二氮䓬类、卡马西平、丙戊酸盐、抗精神病药、抗抑郁药、美沙酮和双硫仑在内的同时使用药物之间的不良药代动力学和药效学相互作用。由于临床医生往往未认识到此类影响，因此没有关于其发生率的准确流行病学数据。
