An inquest into the death of a UK cardiologist has heard that ciprofloxacin is linked to a rare risk of suicide.
A UK coroner has warned that the common antibiotic ciprofloxacin may have a rare risk of suicide after the death of a cardiologist 11 days after starting the medication.
Dr Robert Stevenson, 63, was a “respected and experienced” consultant cardiologist who had recently retired and had no history of mental health problems, the BMJ reported.
The inquest into Dr Stevenson’s death heard that he was undergoing investigations for possible prostate cancer and was prescribed ciprofloxacin to treat prostatitis before a biopsy.
On 30 May, Dr Stevenson went for a walk, then later sent his wife a message saying he had left a note under his pillow.
Coroner Martin Fleming said Dr Stevenson’s note was “uncharacteristically confused and illogical” and revealed “baseless” concerns that he may have developed AIDS after using an HIV tester kit.
“After an intensive police and family search, Dr Stevenson was found hanged in a nearby wood,” the report said.
The coroner said evidence suggested prescribing doctors may not be fully aware of this rare side effect, and patients with depression may be more vulnerable to it.
Commenting on the report, Clinical Associate Professor Kurt Gebauer, a dermatologist at Fremantle Dermatology in Perth, said most dermatologists would prescribe ciprofloxacin “from time to time”.
Professor Gebauer said he occasionally prescribed ciprofloxacin for infections after, for example, a wedge excision of a skin cancer on an ear.
However, he said it was difficult to access because it was only available on the PBS under limited circumstances. “The restrictions are quite rigorous.”
“In my practice it’s not a common drug. We have this idea that it’s just a fancy penicillin, but it does have its side effects. It’s an advanced therapy and it’s not without its side effects.
“Sometimes things go bad, and this is an example. If you’re writing these drugs, be aware of the rare side effects and indications.
“It’s not a simple penicillin. Some of us are very quick to write cipro because it’s a very good and very powerful medication. It’s also one of those drugs that is kept in reserve for antibiotic resistance.
“Be aware that the more exotic the medication, the less comfort we have and knowledge we have.”
During the inquest, the urologist referred the coroner to studies showing that the antibiotics ciprofloxacin and quinolone were linked to a rare risk of suicide.
“On the balance of probabilities … it remained unclear that Dr Stevenson was suffering from this side effect but it remained possible for this to be the case,” Mr Fleming said.
The prescribing doctor did not mention the potential side effect, “since it was not in accord with current advice”, Mr Fleming said.
The coroner sent a report to prevent future deaths to the Medicines and Healthcare Products Regulatory Authority, which has until 1 August to respond.
Ciprofloxacin is a fluoroquinolone, a class of broad-spectrum antibiotics that also includes norfloxacin and moxifloxacin.
In 2020, the TGA said product information for fluoroquinolones should be updated to include precautions regarding potential adverse events of dysglycaemia and psychiatric adverse reactions.
“These medicines have been associated with an increased risk of psychiatric adverse reactions including: toxic psychosis, psychotic reactions progressing to suicidal ideations/thoughts, hallucinations or paranoia; depression, or self-injurious behaviour such as attempted or completed suicide; anxiety, agitation, or nervousness; confusion, delirium, disorientation, or disturbances in attention; insomnia or nightmares; memory impairment,” the TGA said.
“These reactions may occur following the first dose and if patients experience any of these symptoms, they should inform their doctor immediately and discontinue the drug.”
According to the TGA, epidemiological studies have also shown an association between fluoroquinolone antibiotic use and aortic aneurysm and dissection.
