title: Antibiotic-associated encephalopathy.
abstract: 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, we comprehensively review the clinical, radiologic, and electrophysiologic features of antibiotic-associated encephalopathy (AAE). AAE 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). We correlate these 3 clinical phenotypes with underlying pathophysiologic mechanisms of antibiotic neurotoxicity. Familiarity with these types of antibiotic toxicity can improve timely diagnosis of AAE and prompt antibiotic discontinuation, reducing the time patients spend in the delirious state.
authors.affiliation: From the Department of Neurology (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Brigham and Women's Hospital; Department of Neurology (R.R.D., P.R., L.N.G.C.), Massachusetts General Hospital; and Harvard Medical School (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Boston, MA. sbhattacharyya3@partners.org.
authors.forename: Shamik
authors.initials: S
authors.lastname: Bhattacharyya
authors.affiliation: From the Department of Neurology (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Brigham and Women's Hospital; Department of Neurology (R.R.D., P.R., L.N.G.C.), Massachusetts General Hospital; and Harvard Medical School (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Boston, MA.
authors.forename: R Ryan
authors.initials: RR
authors.lastname: Darby
authors.affiliation: From the Department of Neurology (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Brigham and Women's Hospital; Department of Neurology (R.R.D., P.R., L.N.G.C.), Massachusetts General Hospital; and Harvard Medical School (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Boston, MA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Raibagkar
authors.affiliation: From the Department of Neurology (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Brigham and Women's Hospital; Department of Neurology (R.R.D., P.R., L.N.G.C.), Massachusetts General Hospital; and Harvard Medical School (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Boston, MA.
authors.forename: L Nicolas
authors.initials: LN
authors.lastname: Gonzalez Castro
authors.affiliation: From the Department of Neurology (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Brigham and Women's Hospital; Department of Neurology (R.R.D., P.R., L.N.G.C.), Massachusetts General Hospital; and Harvard Medical School (S.B., R.R.D., P.R., L.N.G.C., A.L.B.), Boston, MA.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Berkowitz
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001927:Brain Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology; D002511:Cephalosporins / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000009:adverse effects; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D008795:Metronidazole