Psychopathological syndromes in treatment with gyrase inhibitors

Abstract

Psychopathological and neurological adverse drug reactions (ADR) have been repeatedly reported during treatment with gyrase inhibitors (fluorquinolones). Results of earlier studies indicated a high risk for ADR especially in the elderly with high dosage medication, psychiatric history and renal dysfunction. The pathophysiological mechanisms involved in the development of adverse CNS effects are not completely understood. GABA-ergic and monoaminergic mechanisms might play a major part. In a retrospective study conducted by the authors 4189 reports of consultant psychiatric examinations were analyzed. In 29 patients the suspicion of psychopathological ADR during treatment with ofloxacin or ciprofloxacin was documented. Psychopathological findings included delirious states, paranoid, depressive and manic syndromes, agitation, sleep disturbances, sopor and stupor. In elderly patients delirious and paranoid syndromes were predominant, whereas affective disturbances occurred more often in younger patients. In most cases multiple morbidity, liver or kidney diseases, simultaneous treatment with other antibiotics and immunosuppressants, former psychiatric disorders or psychosocial stress factors were present. The results of the study, methodological problems, aspects of risk analysis and implications for medical treatment are discussed.