A retired cardiologist with no history of mental health problems took his own life one week after taking an antibiotic with a “rare” link to suicide, a coroner has found.
Dr. Robert Stevenson, a “respected” and “experienced” consultant cardiologist, hanged himself around a week after he started a course of ciprofloxacin.
Coroner Martin Fleming has issued a warning over potential side-effect of the antibiotic, which is commonly used in the health service. In 2020, UK community pharmacists dispensed around one million prescriptions for ciprofloxacin, according to The Ecologist.
Dr. Stevenson had no history of mental health issues or depression, but just over a week after he started the antibiotics he went for a walk and messaged his wife to say he had left a note under his pillow. He was found hanged in a nearby wood.
The note he left was said to be “uncharacteristically confused and illogical” with “baseless concerns” that he might have Aids after taking an online tester kit, the inquest heard.
The hearing was told he had not been informed about a “potential rare link” to suicidal behaviour in patients who took the drug as this was not in line with medical guidance.
Dr. Stevenson, a consultant cardiologist and general physician at Huddersfield Royal Infirmary, in West Yorkshire, retired in May 2022.
At that time, he had been referred to a urology department for the investigation of possible prostate cancer with a private consultant urologist.
He was prescribed ciprofloxacin, an antibiotic used to treat a number of bacterial infections, to help with the inflammation of his prostate gland and get him ready for an investigative biopsy.
Just over a week later, he went out for his usual walk, having previously not given any indication to his family that they should be concerned for him, the inquest heard.
At 12: 30 pm that afternoon, his wife received a Facebook message from him saying he had left a note under his pillow, which was found to be “uncharacteristically confused and illogical”.
It triggered an intensive police and family search of the surrounding area, and he was later found to have hanged himself.
Fleming issued a warning regarding the antibiotic, which is prescribed for serious conditions. It is used to treat a wide range of bacterial infections including urinary tract infections, chest infections, skin and bone infections, sexually transmitted infections, conjunctivitis, eye infections and ear infections.
‘Consider reviewing current guidelines’
Writing to the Medicines and Healthcare products Regulatory Agency (MHRA), the coroner said doctors may not be aware of the potential side-effect.
“During the inquest, I was referred by Mr Stevenson’s treating urologist to published literature relating to ciprofloxacin and quinolone antibiotics and a potential rare link to suicidal behaviour in patients,” he said.
“Although I found on the balance of probabilities that it remained unclear that he was suffering from this side-effect, it remained possible for this to be the case. I heard evidence to suggest that the prescribing doctor did not reference this side-effect at the time of issuing the prescription to Stevenson, since it was not in accord with current advice.”
“I also heard evidence to suggest that prescribing doctors may not be fully aware of this rare side-effect and that patients suffering from depression may be more vulnerable to it.”
Fleming added that he was concerned “that this potential risk has not been given sufficient emphasis”. He said that the MHRA should consider reviewing the current guidelines for dispensing the medicine and also increase awareness of the side-effect “in order to monitor and mitigate the risks”.
He concluded: “Robert Stevenson intended to take his own life when the balance of his mind was disturbed.”
Dr. Janine Jolly, the MHRA deputy director of benefit/risk evaluation, said: “We are very sorry to hear of Dr. Stevenson’s death and would like to express our sympathies to his family. “
“As with any serious suspected side-effects, reports of fatalities are evaluated by us, including an assessment of post-mortem details if available. We will be reviewing the coroner’s verdict.”
“We will carefully consider the points raised by the coroner in the Regulation 28 Report to consider whether further regulatory action is required to minimize risks to patients and will provide a response upon completion of our investigation.”