Antibiotic-Associated Psychosis in Children and Adolescents: A Systematic Review.

In 30 seconds

This systematic review assessed reported cases of acute psychosis associated with antibiotic treatment in children and adolescents, evaluating the strength of the possible causal relationship. Sixteen articles describing 18 cases were included. Sixteen cases (89%) were judged highly suggestive of a potential association, including three in which psychosis recurred after the same antibiotic was given again. Five antibiotic classes were implicated. In most cases, psychosis began and resolved within one week of starting and stopping the antibiotic, respectively; almost three-quarters did not require antipsychotic treatment. The underlying mechanisms remain unclear.

Key findings

• Sixteen of 18 cases (89%) were judged highly suggestive of a potential causal relationship; three involved recurrence after rechallenge with the same antibiotic.
• Five antibiotic classes were implicated: fluoroquinolones, isoniazid, macrolides, penicillins, and trimethoprim-sulfamethoxazole.
• In most cases, psychosis began and resolved within one week of antibiotic initiation and discontinuation, respectively.
• Almost three-quarters of reported cases did not require antipsychotic treatment.

Why it matters

The review highlights acute psychosis as a potential adverse effect to consider when assessing new psychiatric symptoms in children and adolescents receiving antibiotics. The reported timing and recurrence on rechallenge strengthen concern for an association in some cases, while the evidence remains based on published case reports and does not establish incidence or prove causation.

What to keep in mind

Evidence came from 18 published cases, so it cannot establish incidence or reliably quantify risk; the review also notes that the mechanisms remain unclear.