“Delirium is a common and costly complication of hospitalization. Although medications are a known cause of delirium, antibiotics are an underrecognized class of medications associated with delirium. In this article, [the authors] comprehensively review the clinical, radiologic, and electrophysiologic features of antibiotic-associated encephalopathy (AAE). Antibiotic-associated encephalopathy can be divided into 3 unique clinical phenotypes: encephalopathy commonly accompanied by seizures or myoclonus arising within days after antibiotic administration (caused by cephalosporins and penicillin); encephalopathy characterized by psychosis arising within days of antibiotic administration (caused by quinolones, macrolides, and procaine penicillin); and encephalopathy accompanied by cerebellar signs and MRI abnormalities emerging weeks after initiation of antibiotics (caused by metronidazole).” In the paper, the three clinical phenotypes are correlated with underlying pathophysiologic mechanisms of antibiotic neurotoxicity. The authors state that familiarity with these types of antibiotic toxicity can improve timely diagnosis of antibiotic-associated encephalopathy and prompt antibiotic discontinuation, reducing the time patients spend in the delirious state.
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Bhattacharyya S, Darby RR, Raibagkar P, Gonzalez Castro LN and Berkowitz AL: Antibiotic-associated encephalopathy. Neurology [Epub ahead of print, February 17, 2016; pii: 10.1212/WNL.0000000000002455]
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http://www.ncbi.nlm.nih.gov/pubmed/26888997