Psychosis as an Adverse Effect of Antibiotics in Children and Adolescents.

Abstract

Background: Adverse neuropsychiatric effects of antibiotics-ranging from insomnia to psychosis and delirium-have been documented in adults; however, there is less extensive research in children and adolescents. The tetracycline antibiotic minocycline has been investigated as an adjunctive treatment in autism and in adults with psychotic disorders. The present study investigated the prevalence of spontaneously reported adverse drug reactions (ADRs) of psychotic symptoms in children and adolescents for antibiotics and the odds of psychosis ADRs compared to minocycline for individual antibiotics and antibiotic classes.

Methods: We searched the US FDA Adverse Event Reporting System (FAERS) from inception through August 2025 for which an antibiotic was the suspected agent of an adverse drug reaction (ADR).

Results: We investigated 24 different antibiotics, comprising 30,884 ADRs, including 417 psychosis ADRs (1.4% of all ADRs). For psychosis ADRs, the mean age was 10.5, 55% were male, and 38% were hospitalized. Compared to minocycline, exposure to any antibiotic was associated with a significant, more than 3-fold increased reported odds of a psychosis ADR (rOR=3.26, 99% CI=1.27-9.10). Ten individual antibiotics were associated with significantly increased reported odds of a psychosis ADR compared to minocycline (rORs=3.72 to 8.74), including sulfonamides, penicillins, fluoroquinolones, macrolides, and cephalosporins.

Conclusions: Findings suggest that psychosis is a potential adverse effect of antibiotic treatment in children and adolescents, though risks vary by specific agents. Future studies in this area are needed to identify specific underlying biological mechanisms that contribute to these associations. Findings may also inform clinical decisions regarding the selection of antibiotic therapy in vulnerable patient populations.