{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T16:47:21Z","timestamp":1793810841494,"version":"4.6.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fluoroquinolones are broad-spectrum antibiotics with significant antimicrobial activity. Despite their therapeutic benefits, they are associated with a range of adverse drug reactions (ADRs), particularly those affecting the central nervous system (CNS). This study aimed to analyze the psychiatric ADRs linked to fluoroquinolones using data from the FDA Adverse Event Reporting System (FAERS) database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective pharmacovigilance study was conducted using FAERS data from Q1 2004 to Q4 2023. The data processing phase involved the FDA-recommended deduplication method, and ADRs were classified according to Medical Dictionary for Regulatory Activities (MedDRA). Disproportionality analysis was performed using the reporting odds ratio (ROR), and statistical significance was assessed using the Chi-square test or Fisher\u2019s exact test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study identified 84,777 reports associated with fluoroquinolones, with 359,480 Preferred Terms-annotated entries, 27,816 of these reports were psychiatric ADRs. Mood disorders were the most frequently reported, including anxiety, depression, and delirium, with some reports escalating to suicidal ideation and behaviors. The Standardized MedDRA Query classification system was used to categorize these ADRs into Depression, Suicide\/self-injury, Psychosis and psychotic disorders, and Non-infectious encephalopathy\/delirium. Ciprofloxacin was most frequently linked to depression and suicidal ideation, while moxifloxacin showed a robust correlation with delirium. The risk of psychiatric ADRs varied by age group, with affective disorders more prevalent in adults under 65 and psychosis and delirium in those over 65.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fluoroquinolones are associated with a range of psychiatric ADRs, with notable differences between the drugs in the class. The study highlights the need for caution in prescribing fluoroquinolones, particularly for patients with pre-existing mental health conditions or those in higher risk age groups. The findings also underscore the importance of considering age-specific preventive strategies when administering these antibiotics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2024.1435923","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:52:04Z","timestamp":1728867124000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":29,"title":["Psychiatric disorders associated with fluoroquinolones: a pharmacovigilance analysis of the FDA adverse event reporting system database"],"prefix":"10.3389","volume":"15","author":[{"given":"Wen-Long","family":"Xie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Lan","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo-Qing","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan-Xi","family":"Mei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Ji","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"82.e5","DOI":"10.1016\/j.genhosppsych.2010.07.002","article-title":"A man who wanted to commit suicide by hanging himself: an adverse effect of ciprofloxacin","volume":"33","author":"Ahmed","year":"2011","journal-title":"Gen. Hosp. Psych."},{"key":"B2","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1152\/jn.1991.66.2.497","article-title":"Quinolones and fenbufen interact with GABAA receptor in dissociated hippocampal cells of rat","volume":"66","author":"Akaike","year":"1991","journal-title":"J. Neurophysiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1097\/01.NAJ.0000494691.55746.90","article-title":"The FDA revises boxed warning for fluoroquinolones-again","volume":"116","author":"Aschenbrenner","year":"2016","journal-title":"Am. J. Nurs."},{"key":"B4","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1136\/dtb.2023.000069","article-title":"MHRA issues two updates on fluoroquinolone safety","volume":"62","year":"2024","journal-title":"Drug Ther. Bull."},{"key":"B5","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.phrs.2006.03.004","article-title":"Effects of sparfloxacin on CNS functions and urinary hydroxyproline in mice","volume":"54","author":"Bharal","year":"2006","journal-title":"Pharmacol. Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"416","DOI":"10.9758\/cpn.2017.15.4.416","article-title":"High dose ofloxacin-induced bimodal hallucinations in a 4\u00a0Years old child","volume":"15","author":"Bhattacharya","year":"2017","journal-title":"Clin. Psychopharmacol. Neurosci."},{"key":"B7","doi-asserted-by":"publisher","first-page":"189","DOI":"10.4103\/0253-7613.108316","article-title":"Ofloxacin-induced hallucinations","volume":"45","author":"Chauhan","year":"2013","journal-title":"Indian J. Pharmacol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.1016\/0028-3908(95)00106-9","article-title":"A patch clamp study of the effects of ciprofloxacin and biphenyl acetic acid on rat hippocampal neurone GABAA and ionotropic glutamate receptors","volume":"34","author":"Halliwell","year":"1995","journal-title":"Neuropharmacology"},{"key":"B9","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1002\/cpt.302","article-title":"Big data and adverse drug reaction detection","volume":"99","author":"Harpaz","year":"2016","journal-title":"Clin. Pharmacol. Ther."},{"key":"B10","doi-asserted-by":"publisher","first-page":"779","DOI":"10.4149\/BLL_2023_120","article-title":"The frequency of, and predisposing risk factors for, ciprofloxacin-induced neuro-psychiatric adverse drug reactions","volume":"124","author":"Hartinger","year":"2023","journal-title":"Bratisl. Lek. Listy."},{"key":"B11","doi-asserted-by":"publisher","first-page":"374","DOI":"10.3109\/15376516.2015.1026008","article-title":"Ciprofloxacin-induced neurotoxicity: evaluation of possible underlying mechanisms","volume":"25","author":"Ilgin","year":"2015","journal-title":"Toxicol. Mech. Methods."},{"key":"B12","doi-asserted-by":"publisher","first-page":"212","DOI":"10.4103\/0976-3147.98256","article-title":"Levofloxacin-induced acute anxiety and insomnia","volume":"3","author":"Kandasamy","year":"2012","journal-title":"J. Neurosci. Rural. Pract."},{"key":"B13","doi-asserted-by":"publisher","first-page":"54","DOI":"10.12788\/jcso.0167","article-title":"Fluoroquinolone-related neuropsychiatric and mitochondrial toxicity: a collaborative investigation by scientists and members of a social network","volume":"14","author":"Kaur","year":"2016","journal-title":"J. Community Support Oncol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1016\/j.tibs.2021.01.011","article-title":"Direct structural insights into GABA(A) receptor pharmacology","volume":"46","author":"Kim","year":"2021","journal-title":"Trends biochem. Sci."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.1016\/j.ejim.2018.07.012","article-title":"Fluoroquinolone-associated suicide","volume":"55","author":"Kommalapati","year":"2018","journal-title":"Eur. J. Intern. Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.psym.2011.05.003","article-title":"Fluoroquinolone-induced suicidal ideation and suicidality","volume":"53","author":"Labay-Kamara","year":"2012","journal-title":"Psychosomatics"},{"key":"B17","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.genhosppsych.2009.03.002","article-title":"Fluoroquinolone-induced suicidal ideation","volume":"32","author":"Lasalvia","year":"2010","journal-title":"Gen. Hosp. Psych."},{"key":"B18","doi-asserted-by":"publisher","first-page":"109","DOI":"10.2165\/00002018-200326020-00004","article-title":"Adverse drug reactions related to the use of fluoroquinolone antimicrobials: an analysis of spontaneous reports and fluoroquinolone consumption data from three Italian regions","volume":"26","author":"Leone","year":"2003","journal-title":"Drug Saf."},{"key":"B19","doi-asserted-by":"crossref","DOI":"10.2174\/15748863113089990043","article-title":"Levofloxacin-induced delirium in a patient suffering from schizoaffective disorder and multiple sclerosis. Curr","author":"Lertxundi","year":"2013","journal-title":"Drug Saf"},{"key":"B20","doi-asserted-by":"publisher","first-page":"123","DOI":"10.4103\/ijp.IJP_291_17","article-title":"Levofloxacin-induced tactile hallucination and acute anxiety reaction","volume":"51","author":"Maharani","year":"2019","journal-title":"Indian J. Pharmacol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1093\/cid\/ciab150","article-title":"Fluoroquinolones: friends or foes?","volume":"73","author":"Mahoney","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1016\/j.clinthera.2014.09.020","article-title":"Neurotoxicity with antimicrobials in the elderly: a review","volume":"36","author":"Mattappalil","year":"2014","journal-title":"Clin. Ther."},{"key":"B23","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/BF02245590","article-title":"Aggression, anxiety and vocalizations in animals: GABAA and 5-HT anxiolytics","volume":"121","author":"Miczek","year":"1995","journal-title":"Psychopharmacology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e2224892","DOI":"10.1001\/jamanetworkopen.2022.24892","article-title":"Association of higher-dose fluoroquinolone therapy with serious adverse events in older adults with advanced chronic kidney disease","volume":"5","author":"Muanda","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"B25","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1097\/JCP.0000000000000696","article-title":"Ciprofloxacin associated exacerbation of anxiety in an elderly patient: a review of anxiogenic potential of fluoroquinolones","volume":"37","author":"Munjal","year":"2017","journal-title":"J. Clin. Psychopharmacol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2647","DOI":"10.1111\/jgs.13856","article-title":"Acute confusional syndrome induced by moxifloxacin in an elderly man","volume":"63","author":"Pozo","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"B27","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3390\/biology13020084","article-title":"Friend or foe: protein inhibitors of DNA gyrase","volume":"13","author":"Ruan","year":"2024","journal-title":"Biology-Basel"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1805","DOI":"10.1021\/acschemneuro.2c00200","article-title":"Stoichiometry-selective antagonism of \u03b14\u03b22 nicotinic acetylcholine receptors by fluoroquinolone antibiotics","volume":"13","author":"Sanders","year":"2022","journal-title":"ACS Chem. Neurosci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.psym.2017.11.001","article-title":"Fluoroquinolone-related neuropsychiatric events in hospitalized veterans","volume":"59","author":"Sellick","year":"2018","journal-title":"Psychosomatics"},{"key":"B30","first-page":"1028","article-title":"Anxiogenic potential of ciprofloxacin and norfloxacin in rats","volume":"48","author":"Sen","year":"2007","journal-title":"Singap. Med. J."},{"key":"B31","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.neuropharm.2018.07.009","article-title":"Identification by virtual screening and functional characterisation of novel positive and negative allosteric modulators of the \u03b17 nicotinic acetylcholine receptor","volume":"139","author":"Smelt","year":"2018","journal-title":"Neuropharmacology"},{"key":"B32","doi-asserted-by":"publisher","first-page":"160094","DOI":"10.1016\/j.scitotenv.2022.160094","article-title":"Enrofloxacin exposure induces anxiety-like behavioral responses in zebrafish by affecting the microbiota-gut-brain axis","volume":"858","author":"Tian","year":"2023","journal-title":"Sci. Total Environ."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.3390\/ph16081105","article-title":"Depressive and other adverse CNS effects of fluoroquinolones","volume":"16","author":"Wierzbinski","year":"2023","journal-title":"Pharmaceuticals"},{"key":"B34","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s40261-017-0498-z","article-title":"Neuropsychiatric effects of antimicrobial agents","volume":"37","author":"Zareifopoulos","year":"2017","journal-title":"Clin. Drug Invest."},{"key":"B35","doi-asserted-by":"publisher","first-page":"101967","DOI":"10.1016\/j.eclinm.2023.101967","article-title":"Psychiatric disorders associated with immune checkpoint inhibitors: a pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) database","volume":"59","author":"Zhou","year":"2023","journal-title":"EClinicalMedicine"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2024.1435923\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:52:07Z","timestamp":1728867127000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2024.1435923\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,14]]},"references-count":35,"alternative-id":["10.3389\/fphar.2024.1435923"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2024.1435923","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,14]]},"article-number":"1435923"}}