Cardiac risks associated with antibiotics: azithromycin and levofloxacin

Abstract

Introduction Azithromycin and levofloxacin have been shown to be efficacious in treating infections. The adverse drug events associated with azithromycin and levofloxacin were considered rare. However, the US FDA released warnings regarding the possible risk of QT prolongation with azithromycin and levofloxacin. Areas covered Case reports/case series, observational studies and clinical trials assessing cardiovascular risks associated with azithromycin and levofloxacin were critically reviewed, including 15 case reports/series, 5 observational studies and 5 clinical trials that investigated the cardiac risks associated azithromycin and levofloxacin. Expert opinion Results are discordant. Two retrospective studies utilizing large databases demonstrated an increased risk of cardiovascular death with azithromycin, when azithromycin was compared with amoxicillin. Two other retrospective studies found no difference in cardiovascular death associated with azithromycin and other antibiotics. For levofloxacin, the increased risk of cardiovascular death was only found in one retrospective study. Therefore, the risks and benefits of antibacterial therapies should be considered when making prescription decisions. This study should not preclude clinicians from avoiding azithromycin and levofloxacin. If a patient has an indication to receive an antibiotic and if azithromycin or levofloxacin is needed, it may be used, but the potential risks must be understood.

Increased risk of major adverse cardiac events following the onset of acute exacerbations of COPD

“…32,33 Similarly, exacerbations are often also treated with antibiotics. Although some antibiotics may increase the risk of cardiac events, 34,35 it is the site of infection more than the choice of antibiotic causing the increased risk. 36 Altogether, the influence of time-dependent confounding caused by these drugs cannot be ruled out.…”

Targeted analysis of six emerging derivatives or metabolites together with 25 common macrolides in milk using Quick, Easy, Cheap, Effective, Rugged and Safe extraction and ultra‐performance liquid chromatography quadrupole/electrostaticfield orbitrap mass spectrometry

“…It also has been reported that the long-term, high-dose use of meleumycin can cause dysbacteriosis such as glossitis, angular cheilitis, and pseudomembranous colitis [12]. The other derivatives and metabolites whose structure are similar to the parent drug also have some toxicity and ecotoxicological effects [13][14][15][16][17][18][19][20]. In terms of these six compounds, telithromycin, kirromycin, and meleumycin were new generation of macrolide derivatives, N-demethyl-roxithromycin, Ndemethyl-clarithromycin, and erythromycin A oxime were three metabolites of macrolides.…”

Comparative Study of the Effect of Macrolide Antibiotics Erythromycin, Clarithromycin, and Azithromycin on the ERG1 Gene Expression in H9c2 Cardiomyoblast Cells

“…QT interval represents the duration between ventricular depolarization and repolarization on the ECG [35,36]. The prolonged QT interval can be due to congenital heart defects or QT-prolonging drugs, involved in extending the time of the cardiac muscle action potential [37][38][39] Some studies also suggest that increased reactive oxygen species (ROS) production will change the kinetics of hERG potassium conductivity. In a study conducted by Salimi and his colleagues, the isolated heart mitochondria from cardiomyocytes were exposed to erythromycin, azithromycin and clarithromycin.…”