Charles Hugh Rendell · Prevention of Future Deaths report

I conducted an Inquest into the death of Mr Charles Hugh Rendell that was heard at Reading Town Hall on 5th January 2017. The conclusion of the Inquest was that Mr Rendell took his own life.

Mr Rendell was a 76 year old gentleman who underwent a needle biopsy of the prostate on 19th September 2016 at Wexham Park Hospital for diagnostic purposes. Post procedure, he was prescribed Ciprofloxacin 500mg twice daily for five days. He had no history of depression or mental health problems.

On the morning of his death on 24th September 2016, he was found by a neighbour wandering in a state of confusion some 8 miles from his home and was returned safely. Later that day, the same neighbour saw Mr Rendell wheel his bicycle with a stool attached, round to his nearby garage block. When the neighbour checked Mr Rendell a little later, Mr Rendell was found hanging in the garage. No note was left.

During the course of the Inquest, I referred to a letter I had received from ████████
████████, Acting Head of Pharmacovigilance at your company dated 28 November 2016. I was also referred to a variety of published literature relating to Ciprofloxacin and Quinolone Antibiotics and a potential link to suicide behaviour in patients.

(1) Apart from the fact that Mr Rendell had undergone a diagnostic biopsy to test for the possibility of Prostate Cancer, the only change in his daily routine was the prescription of Ciprofloxacin medication.

(2) Ciprofloxacin carries warnings/precautions that, in rare cases, depression or psychosis can progress to suicidal ideations/thoughts culminating in attempted suicide or completed suicide. However, it is unclear how clearly this is made known to Ciprofloxacin users.

(3) The literature suggests that this type of side effect can occur even soon after commencing Ciprofloxacin at a comparatively low dose. As it is an antibiotic, there is no compelling reason why patients should expect to have this effect unless this fact, and potential symptoms, are brought clearly to their attention by prescribing clinicians.

(4) One of Mr Rendell’s family members is a general practitioner in New Zealand. At the Inquest, she advised that she had no knowledge of the potential effect of Ciprofloxacin and, in conversation with her colleagues, nor did they. I am therefore concerned that this potential risk has not been given sufficient emphasis and that consideration should be given to prescribing clinicians highlighting the symptoms and suggesting to patients that they are alert of the possibility and react appropriately.