Choreoathetosis Is a Possible Adverse Event of a Commonly Used Antibiotic

BACKGROUND Choreoathetosis (CAS) is attributed to a few neuropsychiatric drugs; however, it is scarcely reported with commonly used antibiotics. AIMS To present a case of ceftriaxone (CTX)-induced CAS and to perform a literature review. SETTING A medical teaching hospital. CASE HISTORY An 83-year-old female with end stage renal disease was prescribed CTX 2 g/day intravenously and doxycycline (DXC) 200 mg/day orally for the treatment of acute community-acquired systemic infection. CAS developed 3 days after the administration of both drugs. Withdrawal of CTX and DXC yielded complete resolution of the CAS on the following day. Neither neurological adverse events related to DXC use nor pharmacological interaction between DXC and CTX was reported. Therefore, the CAS development was attributed to CTX. CONCLUSION CTX as well as other ß-lactam antibiotics induce glutamate excess in the striatum and cerebral cortex, resulting in neurological hyperexcitability disorders. Dosage adjustment of these antibiotics in relation to the patients' renal clearance is warranted.