Neuroleptic malignant syndrome and Escherichia coli urosepsis

Article Abstract:

Neuroleptic drugs are used to treat psychiatric illness and sometimes to control agitation in the elderly or to treat nausea. These drugs are known to cause a number of possible side effects. Neuroleptic malignant syndrome (NMS) is a lesser known one of these side effects. It is a severe and sometimes deadly complication. The number of cases of NMS reported has doubled each year since it was first described in 1980. Early diagnosis and treatment is imperative. This study examines the case of one patient with NMS. He was an 89-year-old man who appeared lethargic, dehydrated, and pale. Neurological examination found lethargy and rigidity. A symmetrical rash appeared on his feet and thighs. He had been taking thioridazine, a neuroleptic drug, for two weeks. Urosepsis, urinary tract infection, was diagnosed but was not thought completely accountable for the symptoms. NMS was also diagnosed because of the recent introduction of neuroleptic medication. Antibiotic treatment was begun, the neuroleptic drug was discontinued, and the patient was hydrated. Blood cultures found Escherichia coli responsible for the urosepsis. The patient improved with this treatment. NMS generally appears around two weeks after drug therapy with neuroleptics is begun. There does not appear to be a relationship between dose and development of NMS. A number of contributing factors may be involved, including exhaustion, dehydration, malnutrition, infection, lithium therapy, and AIDS. Symptoms besides those already described include rapid heart rate, altered consciousness, abnormal blood pressure, tremor, rapid breathing, as well some laboratory features. Death can be caused by heart, kidney or respiratory failure. The exact cause of NMS is not known. When NMS is suspected, neuroleptics should be removed immediately and supportive treatment should be initiated. A number of new drugs are being tested to treat this problem. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Antipsychotic drugs, Antipsychotic agents, Escherichia coli infections, Neuroleptic malignant syndrome

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Erythromycin-induced carbamazepine toxicity: a continuing problem

Article Abstract:

Doctors continue to prescribe erythromycin or related antibiotics for children taking the anti-seizure drug carbamazepine despite the established toxicity of the drug combination. Toxic symptoms include drowsiness, lethargy, lack of muscle coordination, vomiting, and abnormal eye movements. Heart block and kidney and liver failure have also been reported. Erythromycin inhibits the liver's ability to metabolize carbamazepine, so it rapidly accumulates to toxic levels. Three cases of erythromycin-carbamazepine toxicity were treated at New England Medical Center in Boston within a six-month period. In all cases both medications were discontinued and symptoms rapidly resolved. Possible reasons for the error include prescribing brand name antibiotic combinations without realizing the formula contains erythromycin, not realizing that clarithromycin is a closely related drug, and not inquiring about other medications.

Physiological aspects, Erythromycin, Carbamazepine

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