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Abstract: FR-PO479

Antibiomania With Intraperitoneal Ceftazidime: The First Case Report

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Rasheed, Abdul Hannan A., Edward Hines Junior VA Hospital, Hines, Illinois, United States
  • Palleti, Sujith Kumar, Edward Hines Junior VA Hospital, Hines, Illinois, United States
  • Wadhwa, Anuradha, Edward Hines Junior VA Hospital, Hines, Illinois, United States
Introduction

Antibiomania or antibiotic induced mania, is rare (47 published cases with 12 different antimicrobials). Macrolides and quinolones are most implicated followed by beta lactams. We present the first case of mania precipitated by ceftazidime, administered intraperitoneally (IP) for treatment of peritonitis in peritoneal dialysis (PD) patient.

Case Description

55-year-old male with end stage kidney disease (ESKD) due to diabetes and hypertension on PD, history of depression (stable off-medications for a year) presented with abdominal pain. PD effluent was cloudy, WBC’s 2694 with 78% neutrophils. He was started on IP ceftazidime for gram negative rods (culture showed capnocytophaga) with gradual improvement in cell counts. On day 12 of treatment, changes in his behavior were noted (agitation, anxiety and tearful). Psychiatry recommended starting sertraline for depression. Patient was discharged home to complete 3 weeks of ceftazidime. He was readmitted 4 weeks later due to disruptive behavior (delusions, irritability, agitation). Psychiatry diagnosed him with mania due to ceftazidime and started him on divalproex sodium. PD fluid showed recurrence of peritonitis with 7251 WBCs, 95% neutrophils and Enterobacter cloacae on culture. He was treated with cefepime but due to abdominal pain and increasing WBC, PD catheter was removed. He was transitioned to hemodialysis and completed 2 weeks of cefepime. His mental status was monitored on divalproex sodium. After a year of therapy with antipsychotics, his mood remained stable, and he has switched back to PD.

Discussion

This first reported case of antibiomania with IP ceftazidime highlights the importance of recognizing psychiatric side effects of antibiotics which, if left untreated can have devastating effects on patient care and quality of life. There is strong temporal relationship between start of antibiotic and onset of mania symptoms in this case. Underlying psychiatric history may or may not be present. The pathophysiology of antibiomania remains elusive with several postulated hypothesis including disruption of gut microbes and increased excitability of postsynaptic neurons. Remission of mania symptoms with discontinuation of causative agent has only been reported in 1/3rd cases hence treatment with antipsychotics may be required.