RESUMO
BACKGROUND: Antibiomania is a rare but recognized side effect with yet unclear definite pathogenesis although multiple hypotheses have been proposed. The novelty of this case is the suspected pharmacodynamic drug-drug interaction between clarithromycin and amoxicillin-clavulanic acid. CASE PRESENTATION: We present the occurrence of a brief manic episode concerning a 50-year-old man with no psychiatric history, first started on amoxicillin-clavulanic acid therapy and then switched to clarithromycin for left basal pneumonia. Shortly after the antibiotic prescription, he presented psychiatric symptomatology (logorrhea, elevated mood, irritability, increase in physical activity and delusions). The antibiotic was stopped and the patient received lorazepam (2.5 mg p.o.) to treat psychomotor agitation. Approximately 12 h after clarithromycin cessation, amelioration was already observed, supporting the diagnosis of a clarithromycin-induced manic episode. Amoxicillin-clavulanic acid was then reintroduced because of the pneumonia and psychiatric symptoms reemerged. This second antibiotic was also stopped, and 1 week later, the patient was symptom-free. CONCLUSION: The emergence of psychiatric side effects related to antibiotherapy, which is a common treatment, can greatly impact a patient's quality of life. Early recognition and intervention could substantially influence the administered medical care and recovery. Moreover, given the widespread use of antibiotics including in combination, we thought our case report might be clinically useful as a clinical reminder relevant to the use of antibiotic combinations.
Assuntos
Combinação Amoxicilina e Clavulanato de Potássio , Claritromicina , Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Antibacterianos/efeitos adversos , Claritromicina/efeitos adversos , Humanos , Masculino , Mania , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
The prevalence of high blood pressure is increasing and expanding preventive and treatment measures may be useful. Some data in the literature suggest that meditation can play a role not only in stress management but also in blood pressure control and cardiovascular disease prevention. Mechanisms involved may be based on the regulation of emotional and biological responses to stress, by regulation of the autonomous nervous system. This approach is available to everyone interested, has no adverse effects and is not related to any particular religious beliefs.
La prévalence de l'hypertension artérielle est en augmentation et élargir le spectre des mesures à disposition pour sa prévention et son traitement peut être utile. Certaines données de la littérature suggèrent que la méditation pourrait jouer un rôle non seulement dans la gestion du stress, mais aussi dans le contrôle tensionnel et la prévention des maladies cardiovasculaires. Les mécanismes impliqués reposeraient sur la modulation de la réaction émotionnelle et la réponse biologique au stress, via la régulation du système nerveux autonome. Il s'agit d'une méthode accessible à toute personne intéressée, dénuée d'effets secondaires et ne reposant pas sur un système de croyance particulier.