Azithromycin qt prolongation

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    Azithromycin qt prolongation


    For community-acquired pneumonia could put certain patients at unacceptably high risk for arrhythmias. That risk is particularly acute for the QT-interval prolongation that can lead to Torsades de pointes, especially if the drug is combined with other commonly prescribed inpatient medications. That’s the take-home message of a retrospective study done at University of Alabama at Birmingham on azithromycin-prescribing patterns among hospital physicians. Researchers found that 76% of patients in the study who received azithromycin—the subject of an FDA warning in 2013 about prolonged QT risk—were also prescribed one or more additional QT-prolonging drugs. That potentially risky pattern was found even when patients’ baseline ECGs on admission documented borderline or actual QT prolongation. Of the 100 patients studied, 76% received azithromycin and at least one other QT-prolonging drug, with 19% prescribed three or more such drugs in addition to azithromycin. Further, despite the risks inherent in such prescribing, only 43% of patients studied were placed on telemetry. Several antibiotic classes are associated with QTc prolongation: macrolides, quinolones, the antimalarials that share the quinine structure, and many azole antifungals. FDA warned about the proarrhythmic effects of azithromycin in 2013 [i] but it is a recent publication by Rao which brings the message home again with some very disquieting quantitative figures [ii]. 1.6 mio courses of antibiotics in a VA population) the authors found that – compared to amoxicillin – mortality was increased by 47% and 149% with azithromycin (Zithromax®) and levofloxacin (Levoquin®), respectively, during the first 5 days of drug administration. Much of our understanding about QTc prolongation and its impact is based on the moxifloxacin (Avelox®) program. Fortunately, 400 mg is an effective dose resulting in minimal (5-7 msec) QT prolongation. Didn’t they teach us in medical school that erythromycin was one of the safest antibiotics? It certainly helped that Bayer studied the issue upfront and in great detail. An unintended byproduct of this effort: Moxifloxacin became the de-facto positive control for all future Thorough QT studies. Several antibiotics failed because of QT prolongation. However, levofloxacin and azithromycin have been on the market for a long time now, and both have accumulated an impressive safety record. Remember sparfloxacin (Zagam®) and grepafloxacin (Raxar®)? In contrast to most other fluoroquinolones, levofloxacin has a very small effect on QT prolongation, and azithromycin is clearly safer than erythromycin. Are the reported results by an aberration, a population-specific finding only, restricted to a predominantly male, elderly VA population with significant comorbidities and subject to all kinds of drug interactions? There are other studies that confirm these findings [iii].

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    Feb 27, 2014. Keywords arrhythmias; QT prolongation; azithromycin. Erythromycin, azithromycin, and clarithromycin are all listed in risk category 1. Azithromycin Qt Prolongation OnlinePharmacyworldwidestore best ED products - Generic Levitra, Tadalafil Cialis, Vardenafil levitra with lowest price and high quality QT interval prolongation = torsades de pointes. ECG VF. TCA NA. HCTZ = electrocardiogram = ventricular fibrillation = tricyclic antidepressant = not applicable = hydrochlorothiazide. a Associations are based on the strength of evidence that supports whether QT prolongation can occur. This categorization does not delineate an

    Address for correspondence and reprint requests: Rachael Lee, MD, 1900 University Boulevard, Tinsley Harrison Towers 229, Birmingham, AL 35294; Telephone: 205‐934‐5191; Fax: 205‐934‐5155; E‐mail: [email protected]Azithromycin is used in the inpatient setting for a variety of conditions. In 2013, the US Food and Drug Administration released a warning regarding risk for corrected QT (QTc) prolongation and subsequent arrhythmias. Knowledge of inpatient prescribing patterns of QTc prolonging medications with respect to patient risk factors for adverse cardiovascular events can help recognize safe use in light of these new warnings. Seventy‐nine percent of azithromycin use was empiric. Sixty‐five percent of patients received a baseline ECG prior to prescribing azithromycin, of which 60% had borderline or abnormal QTc prolongation. Seventy‐six percent of patients were prescribed 2 or more QTc prolonging medications, of which there were more abnormal ECGs at baseline (In a cohort of hospitalized patients, azithromycin was prescribed despite risk factors for QTc prolongation and administration of interacting medications. Selection of azithromycin by providers appears to be independent from these risk factors, and education and vigilance to drug‐drug interactions may be useful in limiting cardiac events with prescribing azithromycin. (Health Day)—Azithromycin is frequently prescribed to hospitalized patients despite the presence of risk factors for QTc prolongation, according to a study published in the January issue of the Journal of Hospital Medicine. Data were included for 100 inpatients aged 19 years or older who were randomly selected from 1,610 patient encounters and who were administered at least one dose of azithromycin. D., from the University of Alabama at Birmingham, and colleagues examined inpatient prescribing patterns and risk factors for QTc elongation. The researchers found that 79 percent of azithromycin use was empiric. Overall, 65 percent of patients received a baseline electrocardiogram before azithromycin prescription; 60 percent of these patients had borderline or abnormal QTc prolongation. Seventy-six percent of patients were prescribed one or more QTc-prolonging medication in addition to azithromycin, most often ondansetron, trazodone, and moxifloxacin; 19 percent received three or more QTc medications in addition to azithromycin. "In a cohort of hospitalized patients, azithromycin was prescribed despite risk factors for QTc prolongation and administration of interacting medications," the authors write. "Selection of azithromycin by providers appears to be independent from these risk factors, and education and vigilance to drug-drug interactions may be useful in limiting cardiac events with prescribing azithromycin." This document is subject to copyright.

    Azithromycin qt prolongation

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    Consider the facts Though rare, azithromycin can prolong the QT interval. It is bad to have a prolonged QT interval. Individuals vary in their susceptibility to drug-induced QT prolongation. We have no means of detecting QT susceptibility before giving the drug at least not until personalized genomic medicine matures. QT interval prolongation is a class effect among the fluoroquinolones; however, similar to that for the macrolides, azalides, and ketolides, there appears to be some intraclass variability. Several studies have reported the effects of the fluoroquinolones on the I Kr current table 1 58–60. However, levofloxacin and azithromycin have been on the market for a long time now, and both have accumulated an impressive safety record. In contrast to most other fluoroquinolones, levofloxacin has a very small effect on QT prolongation, and azithromycin is clearly safer than erythromycin.

     
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