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A DGReview of :"Delirium
in the elderly resulting from azithromycin therapy"
Surgical Neurology
07/22/2003
By Mary Beth Nierengarten
Acute delirium reported in two elderly people after taking azithromycin took
longer to resolve than similar side effects experienced after the use of
clarithromycin, reports a case study from researchers in California.
Although studies report that about 1% of people taking azithromycin will
experience adverse central nervous system symptoms -- such as vertigo, headache,
and anxiety -- no studies have reported more serious complications such as
delirium or psychosis.
Lawrence A. Cone, MD, DSc, and colleagues from the Eisenhower Medical Center, in
Rancho Mirage, California, report on 2 cases of acute delirium reported in two
elderly patients after taking azithromycin. In both cases, delirium started
within 72 hours of taking azithromycin and lasted from 48 to 72 hours after
stopping treatment.
One patient was a 78-year old man placed on ceftriaxone 1 g IV/day and
azithromycin initially 500 mg, followed by 250 mg orally/day after being
hospitalised with dyspnoea, low-grade fever and productive cough. The patient
started having visual hallucinations after the third day in hospital and
azithromycin was withdrawn 24 hours later. His hallucinations resolved over the
following 72 hours.
The other patient was an 88-year old woman treated with the same combination of
drugs upon entering the hospital with fever, a dry cough, and dyspnea. This
patient started having visual hallucinations with paranoia after 4 days of
treatment. Discontinuation of azithromycin within 24 hours resolved the
hallucinations, but she experienced paranoia and confusion for 2 more days.
Although other neuropsychiatric side effects are associated with agents similar
to azithromycin, such as clarithromycin, the longer duration of symptoms in the
azithromycin-treated patients that these symptoms take longer to resolve because
of the longer half-life of azithromycin, the authors suggest.
In addition, they add, older women may experience more frequent adverse
reactions with azithromycin because they have 30% to 50% higher peak plasma
levels of the drug compared to younger patients and to older men.
Surg Neurol 2003;59:6:509-11.
"Delirium in the elderly resulting from azithromycin therapy"
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