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A Unique ADR Case from an Unexpected Source: Antibiomania Hidden in an Editorial

While reviewing a recently published journal issue, an unusual finding emerged from a section not typically associated with pharmacovigilance insights—the editorial.

Although editorials are generally not indexed in major medical databases and are not intended to report adverse drug reactions (ADRs), this particular piece revealed a clinically meaningful and rare safety signal.

Key observations

This case highlights several important considerations for pharmacovigilance professionals:

  • Valuable ADRs can be identified even in non-indexed publications such as editorials
  • Clinically relevant safety information may be embedded in articles with entirely different objectives
  • Rare adverse reactions may remain underreported, with limited presence in the literature

In this instance, the editorial led to the identification of a very rare ADR—antibiomania—with only around 65 documented cases in the literature.

The case behind the observation

The author of the editorial humorously reflected on the intrusive nature of patient phone calls, noting that callers often disregard timing or context. At the same time, he acknowledged the clinical importance of accessibility.

During one such call, a patient claimed to have solved the fundamental nature of the universe—surpassing Einstein—before midnight. Intrigued, the physician invited the patient for a face-to-face meeting.

During a subsequent coffee meeting, the physician recognized clear symptoms of mania. Further assessment linked the episode to the patient’s recent use of clarithromycin, a commonly prescribed antibiotic.

The condition escalated into a severe manic episode, including violent behavior. However, the symptoms resolved within a few days after discontinuation of the antibiotic and initiation of appropriate antipsychotic treatment.

Clinical relevance

This case serves as a reminder that:

  • Antibiotics such as clarithromycin can induce neuropsychiatric adverse effects
  • Informal clinical interactions can play a critical role in identifying safety signals
  • Pharmacovigilance insights can emerge from unexpected and non-traditional sources

Why this matters

For pharmacovigilance and drug safety professionals, this example underscores the importance of maintaining a broad and attentive approach to literature review. Limiting surveillance to indexed databases alone may result in missed signals, particularly when dealing with rare or atypical adverse reactions.

Conclusion

The identification of antibiomania in an editorial demonstrates that meaningful safety data can surface in unlikely places. Expanding the scope of literature monitoring—even to unconventional sources—can enhance signal detection and improve patient safety outcomes.

Citation:
Honzák R. Pište také pro nás! Medicína pro praxi. 2025;2:75