A case of clarithromycin-induced manic episode (antibiomania).

Antimicrobial-induced mania, a rare but important side-effect of erythromycin and other drugs, is frequently under-recognized. Although its incidence - considering the wide use of antimicrobials - is statistically low, it should be regarded as a potential risk for patients both with and without a history of a mood disorder. Reports of manic reactions induced by antibiotics related mostly to new compounds have increased; a recent review on the topic, including published and non-published reports, found clarithromycin and ciprofloxacin to be the most frequently associated with the development of mania (Abouesh et al., 2002). Clarithromycin (Klaricid®) is an antibiotic useful in the treatment of upper and lower respiratory tract infections, local infections caused by MAC complex ( Mycobacterium avium or M. intracellulare ) and for the eradication of Helicobacter pylori . Common side-effects include nausea or vomiting, abdominal pain and diarrhoea. Rare side-effects include hepatitis, rash, anaphylaxis, Stevens-Johnson syndrome and ventricular arrhythmias. Side-effects to the central nervous system (CNS), which are not common, include anxiety, dizzness, disorientation, hallucination and insomnia. We report here a case of a manic reaction attributed to clarithromycin, in a patient without a previous clinically identified mood disorder.