Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Neurol. Nov 15, 2022; 8(2): 10-13
Published online Nov 15, 2022. doi: 10.5316/wjn.v8.i2.10
Possible convulsion and electroencephalographic abnormality in a patient taking long-term oral clarithromycin: A case report
Wataru Shiraishi
Wataru Shiraishi, Department of Neurology, Kokura Memorial Hospital, Kitakyushu 802-8555, Fukuoka, Japan
Author contributions: Shiraishi W contributed to data collection, writing, and editing of the manuscript.
Informed consent statement: Informed consent was obtained from the patient for publication of this case.
Conflict-of-interest statement: All the authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wataru Shiraishi, MD, PhD, Deputy Director, Doctor, Department of Neurology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu 802-8555, Fukuoka, Japan. whitestone_db5@yahoo.co.jp
Received: September 10, 2022
Peer-review started: September 10, 2022
First decision: October 24, 2022
Revised: October 25, 2022
Accepted: October 31, 2022
Article in press: October 31, 2022
Published online: November 15, 2022
Abstract
BACKGROUND

Clarithromycin is a macrolide antibiotic commonly prescribed to patients with upper respiratory and otolaryngological infections. Neuropsychiatric adverse effects of clarithromycin include agitation, insomnia, delirium, psychosis, and seizure.

CASE SUMMARY

A 52-year-old man was admitted to our hospital with a convulsion. He had > 10-year history of clarithromycin intake for chronic sinusitis. One week before admission, he started to take diltiazem for angina pectoris. On admission, his convulsion subsided. His electroencephalography showed frontal intermittent rhythmic delta activity. One week after he ceased clarithromycin, his electroencephalographic abnormalities disappeared. We suggested that the patient developed convulsions due to increased blood levels of clarithromycin caused by oral administration of diltiazem, which is involved in CYP3A metabolism.

CONCLUSION

Clarithromycin has a relatively high safety profile and is a frequently prescribed drug. However, there are a few previous reports of clarithromycin-related convulsive disorders. Clinicians should be aware of the drug interaction and rare side effects of seizures.

Keywords: Clarithromycin, Convulsion, QT interval prolongation, Seizures, Case report

Core Tip: Clarithromycin is a frequently used medication and has a long history of use. The rarity of reports of convulsions induced by clarithromycin suggests that the induction of convulsions by clarithromycin is a rare phenomenon or has been overlooked. Clarithromycin is a frequently prescribed drug but has many interactions. Therefore, we report this case as a cautionary statement for all neurologists. Also, the measurement of QT time may be a valuable method of assessing clarithromycin excess.