Organic psychosis induced by ofloxacin and metronidazole

Abstract

An 18-year-old black African woman was referred to the on-call medical team by her GP with a history of confusion and stupor. Three weeks before admission she complained of abdominal pain and was treated for urinary tract infection with co-amoxiclav. After 1 week, as her pain persisted, co-amoxiclav was stopped and she was treated for presumed pelvic inflammatory disease with ofloxacin 400 mg twice daily and metronidazole 400 mg three times daily. After 2 days on this combination she started to develop confusion, so her mother stopped the ofloxacin. The next day her GP advised her to also stop the metronidazole. During the next 5 days she became increasingly confused, frightened, almost mute and at times immobile. She was referred urgently to the accident and emergency department from where she was admitted to the medical ward. On examination, apart from a slight temperature which did not persist, her vital signs were normal. The neurological examination was limited because of poor cooperation, but no gro...