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Neurological and Psychiatric Adverse Effects of Antimicrobials

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Abstract

Antimicrobials are a widely used class of medications, but several of them are associated with neurological and psychiatric side effects. The exact incidence of neurotoxicity with anti-infectives is unknown, although it is estimated to be < 1%. Neurotoxicity occurs with all classes of antimicrobials, such as antibiotics, antimycobacterials, antivirals, antifungals and antiretrovirals, with side effects ranging from headaches, anxiety and depression to confusion, delirium, psychosis, mania and seizures, among others. It is important to consider these possible side effects to prevent misdiagnosis or delayed treatment as drug withdrawal can be associated with reversibility in most cases. This article highlights the different neurotoxic effects of a range of antimicrobials, discusses proposed mechanisms of onset and offers general management recommendations. The effects of antibiotics on the gut microbiome and how they may ultimately affect cognition is also briefly examined.

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  1. Section of Infectious Diseases, Department of Medicine, UT Health McGovern Medical School, 6431 Fannin St. MSB 2.112, Houston, TX, 77030, USA

    Madison K. Bangert & Rodrigo Hasbun

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RH has received research support from and is a speaker for BioFire® and has participated in the advisory board for Gilead®. MKB has no conflicts of interest that are directly related to the content of this article.

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Bangert, M.K., Hasbun, R. Neurological and Psychiatric Adverse Effects of Antimicrobials. CNS Drugs 33, 727–753 (2019). https://doi.org/10.1007/s40263-019-00649-9

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